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General NPI Number Information
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NPI Number | 1881108249
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Entity Type | Organization
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Legal Business Name | BENJAMIN A. BAPTIST DDS PC
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 2530 BURR OAK AVE
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1515
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Country | US
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Telephone | 708-442-7414
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Fax |
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Provider Business Mailing Address
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Address Line | 2530 BURR OAK AVE
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1515
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Country | US
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Telephone | 708-442-7414
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. BENJAMIN A BAPTIST
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Credential | DDS
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Telephone | 708-442-7414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019027932
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License Number State | IL
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