Healthcare Provider Details

I. General information

NPI: 1518073006
Provider Name (Legal Business Name): MICHAEL S BEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 N 2ND ST
FAIRFAX OK
74637-2063
US

IV. Provider business mailing address

161 N 2ND ST
FAIRFAX OK
74637-2063
US

V. Phone/Fax

Practice location:
  • Phone: 918-642-3400
  • Fax: 918-642-3370
Mailing address:
  • Phone: 918-642-3400
  • Fax: 918-642-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberOK4341
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: