Provider Demographics
NPI:1457514002
Name:FITZHARRIS, BENJAMIN DOMINIC (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DOMINIC
Last Name:FITZHARRIS
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:NAVAL STATION NORFOLK DENTAL CLINIC
Mailing Address - Street 2:1647 ADMIRAL TAUSSIG BLVD
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511
Mailing Address - Country:US
Mailing Address - Phone:757-953-8635
Mailing Address - Fax:
Practice Address - Street 1:NAVAL STATION NORFOLK DENTAL CLINIC
Practice Address - Street 2:1647 ADMIRAL TAUSSIG BLVD
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-5596
Practice Address - Country:US
Practice Address - Phone:757-953-2786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019811122300000X
HIDT-25261223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist