Provider Demographics
NPI:1952538092
Name:JOHNSON, BENJAMIN WINGAITE (DDS, FACS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WINGAITE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 N MERRIMON AVE UNIT 107
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1392
Mailing Address - Country:US
Mailing Address - Phone:865-771-0818
Mailing Address - Fax:
Practice Address - Street 1:60 N MERRIMON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-1391
Practice Address - Country:US
Practice Address - Phone:865-771-0818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13073204E00000X
AZ101761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery