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General NPI Number Information
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NPI Number | 1538236708
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Entity Type | Individual
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Provider Name | BEN MIBAB DDS MS
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Gender | Male
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 3005 OLD ALABAMA RD SUITE 6000
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City | JOHNS CREEK
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State | GA
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Zip | 30022-8594
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Country | US
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Telephone | 770-552-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 3005 OLD ALABAMA RD SUITE 6000
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City | JOHNS CREEK
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State | GA
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Zip | 30022-8594
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Country | US
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Telephone | 770-552-6800
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | GA 10500
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License Number State | GA
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