Provider Demographics
NPI:1275790859
Name:DICKSON, BENJAMIN MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MARTIN
Last Name:DICKSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W PLAZA STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1124
Mailing Address - Country:US
Mailing Address - Phone:858-755-1591
Mailing Address - Fax:858-755-8396
Practice Address - Street 1:116 W PLAZA STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1124
Practice Address - Country:US
Practice Address - Phone:858-755-1591
Practice Address - Fax:858-755-8396
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist