Provider Demographics
NPI:1215917174
Name:MCGOVERN, BENJAMIN J (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:J
Last Name:MCGOVERN
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:CMR 427 BOX 2875
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09630-0029
Mailing Address - Country:US
Mailing Address - Phone:314-636-9408
Mailing Address - Fax:
Practice Address - Street 1:UNIT 31401
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09630-1401
Practice Address - Country:US
Practice Address - Phone:314-636-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice