Provider Demographics
NPI:1114386505
Name:KWOK, BENJAMIN J (DDS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:KWOK
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949A STATE ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1052
Mailing Address - Country:US
Mailing Address - Phone:740-209-2400
Mailing Address - Fax:
Practice Address - Street 1:1949A STATE ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1052
Practice Address - Country:US
Practice Address - Phone:740-209-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024724122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0228805Medicaid