Provider Demographics
NPI:1538150537
Name:FENGER, BENJAMIN SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:FENGER
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 1:1901 24TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6285
Mailing Address - Country:US
Mailing Address - Phone:612-232-5678
Mailing Address - Fax:
Practice Address - Street 1:319 AEROMEDICAL-DENTAL SQUADRON/SGGD
Practice Address - Street 2:1599 J ST. BLDG. 109A
Practice Address - City:GRAND FORKS AFB
Practice Address - State:ND
Practice Address - Zip Code:58205
Practice Address - Country:US
Practice Address - Phone:701-747-5393
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist