1902866239 NPI number — DR. RICHARD MICHAEL BENIAN D.D.S

Table of content: DEBORAH GALLISON HUBBELL MSW, LCSW-C (NPI 1285623934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902866239 NPI number — DR. RICHARD MICHAEL BENIAN D.D.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENIAN
Provider First Name:
RICHARD
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902866239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11525 HIGHLAND RD
Provider Second Line Business Mailing Address:
SUITE 23
Provider Business Mailing Address City Name:
HARTLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48353-2726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-632-7257
Provider Business Mailing Address Fax Number:
810-632-7305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9880 E GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48116-2468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-227-2626
Provider Business Practice Location Address Fax Number:
810-227-8532
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  14656 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 204E00000X , with the licence number: RB014656 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 190F37120 . This is a "BLUECROSS MEDICAL PIN NUM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P103067 . This is a "BLUE CRSS NETWORK NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: D802670 . This is a "BLUE CROSS DENTAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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