Healthcare Provider Details

I. General information

NPI: 1952538092
Provider Name (Legal Business Name): BENJAMIN WINGAITE JOHNSON DDS, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 N MERRIMON AVE
ASHEVILLE NC
28804-1391
US

IV. Provider business mailing address

60 N MERRIMON AVE UNIT 107
ASHEVILLE NC
28804-1392
US

V. Phone/Fax

Practice location:
  • Phone: 865-771-0818
  • Fax:
Mailing address:
  • Phone: 865-771-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number13073
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10176
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: