Provider Demographics
NPI:1336792423
Name:HOSTETTER, BENJAMIN (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:HOSTETTER
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 1:7445 E EAGLE CREST DR UNIT 2055
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-7154
Mailing Address - Country:US
Mailing Address - Phone:970-290-1028
Mailing Address - Fax:
Practice Address - Street 1:95 S IDAHO RD STE 100
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85119-0006
Practice Address - Country:US
Practice Address - Phone:970-290-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7556122300000X
AZD010900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist