Provider Demographics
NPI:1841648524
Name:ANDERS, BENJAMIN (DDS, MDS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:ANDERS
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-6849
Mailing Address - Country:US
Mailing Address - Phone:843-590-3054
Mailing Address - Fax:
Practice Address - Street 1:4400 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-6849
Practice Address - Country:US
Practice Address - Phone:843-590-3054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10297122300000X
NC10380122300000X
NY060991122300000X
SC104801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist