Healthcare Provider Details

I. General information

NPI: 1215917174
Provider Name (Legal Business Name): BENJAMIN J. MCGOVERN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUDLAGER 250
VILSECK BAYERN
92249
DE

IV. Provider business mailing address

PSC 411 BOX 303
APO AE
09112-0004
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 314-590-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22273
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: