Healthcare Provider Details

I. General information

NPI: 1700849452
Provider Name (Legal Business Name): BENJAMIN R. LAMIELLE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 U.S. RT. 23
PIKETON OH
45661
US

IV. Provider business mailing address

7777 U.S. RT. 23
PIKETON OH
45661
US

V. Phone/Fax

Practice location:
  • Phone: 740-289-3508
  • Fax:
Mailing address:
  • Phone: 740-289-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30021978
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: