MEDICARE: DR. BENJAMIN VANHORN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	5000233	WI

General Provider Information

NPI Number	:	1124176052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN VANHORN

Provider Business Mailing Address
First Line	:	3030 S CHASE AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2610
Country	:	US
Telephone Number	:	414-481-7400
Fax Number	:	414-481-0173

Provider Business Practice Location Address
First Line	:	3030 S CHASE AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2610
Country	:	US
Telephone Number	:	414-481-7400
Fax Number	:	414-481-0173

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. BENJAMIN VANHORN ” Practice Location

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