Healthcare Provider Details

I. General information

NPI: 1205966835
Provider Name (Legal Business Name): BENJAMIN F.D. CHIKES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W FULTON ST
EPHRATA PA
17522-1937
US

IV. Provider business mailing address

480 SNYDER RD
LITITZ PA
17543-7683
US

V. Phone/Fax

Practice location:
  • Phone: 717-738-4901
  • Fax: 717-738-1259
Mailing address:
  • Phone: 717-626-2890
  • Fax: 717-738-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS-025555L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: