Provider Demographics
NPI:1487710174
Name:MENLOVE, BENJAMIN (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:MENLOVE
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 1:4202 AVE Q
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-3174
Mailing Address - Country:US
Mailing Address - Phone:806-507-7777
Mailing Address - Fax:806-507-3037
Practice Address - Street 1:4202 AVENUE Q
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-1708
Practice Address - Country:US
Practice Address - Phone:801-448-2346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX380581223G0001X, 1223G0001X, 125Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125Q00000XDental ProvidersDentistOral Medicine
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38058OtherDENTAL LICENSE
NV4920OtherDENTAL LICENSE