Provider Demographics
NPI:1831327238
Name:MCDOWELL, BENJAMIN D (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:D
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W FRONTIER ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5362
Mailing Address - Country:US
Mailing Address - Phone:928-472-7223
Mailing Address - Fax:928-474-6699
Practice Address - Street 1:200 W FRONTIER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5362
Practice Address - Country:US
Practice Address - Phone:928-472-7223
Practice Address - Fax:928-474-6699
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105021223G0001X
AZD0086101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice