Provider Demographics
NPI:1528796695
Name:BRIGOLI, BENJAMIN (DDS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:BRIGOLI
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 1:6112 MORNING CALM WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2655
Mailing Address - Country:US
Mailing Address - Phone:443-996-1938
Mailing Address - Fax:
Practice Address - Street 1:770 OLD LIBERTY RD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-8500
Practice Address - Country:US
Practice Address - Phone:410-875-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD176341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice