Provider Demographics
NPI:1194074104
Name:EROEN, BENJAMIN LUKE (DDS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LUKE
Last Name:EROEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23560 MADISON ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4708
Mailing Address - Country:US
Mailing Address - Phone:310-539-8616
Mailing Address - Fax:310-530-5155
Practice Address - Street 1:23560 MADISON ST
Practice Address - Street 2:SUITE 214
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4708
Practice Address - Country:US
Practice Address - Phone:310-539-8616
Practice Address - Fax:310-530-5155
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA616751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice