Provider Demographics
NPI:1457727463
Name:CORPRON, BEN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:MICHAEL
Last Name:CORPRON
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 1:1905 CROOKED LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3907
Mailing Address - Country:US
Mailing Address - Phone:919-740-5096
Mailing Address - Fax:
Practice Address - Street 1:5915 LA CROSSE AVE STE 105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-1747
Practice Address - Country:US
Practice Address - Phone:919-740-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice