MEDICARE: DR. BENJAMIN MICHAEL STRAIGHT DDS

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	1223G0001X	General Practice Dentistry	2901020728	MI

General Provider Information

NPI Number	:	1275898348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN MICHAEL STRAIGHT DDS

Provider Business Mailing Address
First Line	:	1601 MARQUETTE ST
Second Line	:	SUITE #2
City	:	BAY CITY
State	:	MI
Zip	:	48706-4196
Country	:	US
Telephone Number	:	989-686-1133
Fax Number	:	989-686-1914

Provider Business Practice Location Address
First Line	:	1601 MARQUETTE ST
Second Line	:	SUITE #2
City	:	BAY CITY
State	:	MI
Zip	:	48706-4196
Country	:	US
Telephone Number	:	989-686-1133
Fax Number	:	989-686-1914

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

Provider Enumeration Date	:	07/05/2012
Last Update Date	:	05/10/2016

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