MEDICARE: BENJAMIN ROSS RECORD DDS, APDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1912711540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENJAMIN ROSS RECORD DDS, APDC

Provider Business Mailing Address
First Line	:	15110 WAX RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-5423
Country	:	US
Telephone Number	:	225-261-1580
Fax Number	:

Provider Business Practice Location Address
First Line	:	15110 WAX RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-5423
Country	:	US
Telephone Number	:	225-261-1580
Fax Number	:	225-261-4065

Authorized Official
Title or Position	:	OWNER
Name	:	BENJAMIN RECORD
Credential	:	DDS
Telephone Number	:	225-261-1580

Provider Enumeration Date	:	02/04/2025
Last Update Date	:	02/11/2025

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