MEDICARE: DR. BENJAMIN PETRY 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	122300000X	Dentist	7809	NE

General Provider Information

NPI Number	:	1730828369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN PETRY DDS

Provider Business Mailing Address
First Line	:	3101 CRESCENT DR APT 315
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-1076
Country	:	US
Telephone Number	:	505-850-3407
Fax Number	:

Provider Business Practice Location Address
First Line	:	343 N COTNER BLVD
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-2315
Country	:	US
Telephone Number	:	402-466-1914
Fax Number	:

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	07/11/2023

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Directions to “ DR. BENJAMIN PETRY DDS” Practice Location

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