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General NPI Number Information
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NPI Number | 1023692597
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Entity Type | Individual
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Provider Name | BEN JOSEPH DDS
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Gender | Male
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 3425 S KING DR
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City | CHICAGO
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State | IL
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Zip | 60616-4108
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Country | US
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Telephone | 312-313-9777
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N JEFFERSON ST APT 909
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City | CHICAGO
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State | IL
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Zip | 60661-1263
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Country | US
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Telephone | 937-901-1787
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.033064
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License Number State | IL
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