Provider Demographics
NPI:1548713712
Name:C. BEN LENNON D.D.S., INC.
Entity type:Organization
Organization Name:C. BEN LENNON D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BEN
Authorized Official - Last Name:LENNON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-725-9485
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:DELTAVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23043-0736
Mailing Address - Country:US
Mailing Address - Phone:804-776-9484
Mailing Address - Fax:804-776-7487
Practice Address - Street 1:15613 GENERAL PULLER HWY
Practice Address - Street 2:
Practice Address - City:DELTAVILLE
Practice Address - State:VA
Practice Address - Zip Code:23043
Practice Address - Country:US
Practice Address - Phone:804-779-9484
Practice Address - Fax:804-776-7487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401007109261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental