Provider Demographics
NPI:1720862717
Name:RASMUSSEN, BENJAMIN NORMAN JENS (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:NORMAN JENS
Last Name:RASMUSSEN
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 1:1800 LINCOLN WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2570
Mailing Address - Country:US
Mailing Address - Phone:208-765-3322
Mailing Address - Fax:208-765-1024
Practice Address - Street 1:1800 LINCOLN WAY STE 100
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2570
Practice Address - Country:US
Practice Address - Phone:208-765-3322
Practice Address - Fax:208-765-1024
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-5545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist