Provider Demographics
NPI:1588967582
Name:DURAN, BENJAMIN A (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:A
Last Name:DURAN
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 1:1817 N RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8069
Mailing Address - Country:US
Mailing Address - Phone:909-879-1024
Mailing Address - Fax:909-879-1058
Practice Address - Street 1:1817 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8069
Practice Address - Country:US
Practice Address - Phone:909-879-1024
Practice Address - Fax:909-879-1058
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40810122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist