Provider Demographics
NPI:1770154247
Name:RALSTON, BENJAMIN NESBITT (DMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:NESBITT
Last Name:RALSTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5935 LUDWIG RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-1146
Mailing Address - Country:US
Mailing Address - Phone:248-882-3744
Mailing Address - Fax:
Practice Address - Street 1:443 W HURON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3412
Practice Address - Country:US
Practice Address - Phone:312-267-1917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist