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General NPI Number Information
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NPI Number | 1720863863
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Entity Type | Individual
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Provider Name | BENJAMIN ANOWIA
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Gender | Male
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 3900 SAN FERNANDO RD STE 1017A
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City | GLENDALE
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State | CA
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Zip | 91204-2899
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Country | US
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Telephone | 818-528-4844
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Fax |
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Provider Business Mailing Address
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Address Line | 2242 ALAROSE WAY
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City | RIVERBANK
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State | CA
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Zip | 95367-9531
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Country | US
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Telephone | 209-988-7986
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 109193
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License Number State | CA
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