Provider Demographics
NPI:1316341613
Name:BROWN, BENJAMIN (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0842
Mailing Address - Country:US
Mailing Address - Phone:702-427-5933
Mailing Address - Fax:
Practice Address - Street 1:6655 W SAHARA AVE STE A106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0843
Practice Address - Country:US
Practice Address - Phone:702-876-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX391711223E0200X
NVS7-118C1223E0200X
UT90437479922122300000X
VA0442000373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist