Provider Demographics
NPI:1932228350
Name:ZIEGLER, BENJAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:ZIEGLER
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 1:6254 97TH PL
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1346
Mailing Address - Country:US
Mailing Address - Phone:718-271-7171
Mailing Address - Fax:718-271-7744
Practice Address - Street 1:6254 97TH PL
Practice Address - Street 2:SUITE 2F
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1346
Practice Address - Country:US
Practice Address - Phone:718-271-7171
Practice Address - Fax:718-271-7744
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0444791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02318174Medicaid
NY0016917OtherDORAL DENTAL USA PROVIDER