Provider Demographics
NPI:1962606582
Name:SISON, BENJAMIN S (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:S
Last Name:SISON
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 1:5061 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3417
Mailing Address - Country:US
Mailing Address - Phone:415-587-1170
Mailing Address - Fax:
Practice Address - Street 1:5 SANTA ROSA AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-2630
Practice Address - Country:US
Practice Address - Phone:415-586-5955
Practice Address - Fax:415-586-5966
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice