Provider Demographics
NPI:1992475412
Name:BEN WHITTED, DDS, LLC
Entity type:Organization
Organization Name:BEN WHITTED, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:990-327-8090
Mailing Address - Street 1:11808 SE SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9308
Mailing Address - Country:US
Mailing Address - Phone:503-698-1112
Mailing Address - Fax:
Practice Address - Street 1:11808 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9308
Practice Address - Country:US
Practice Address - Phone:503-698-1112
Practice Address - Fax:971-224-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental