Pridemore, Benjamin M

Pridemore, Benjamin M is an sole proprietor health care provider with primary practice located at 23 John Maddox Dr Nw , Rome GA 30165-1413. He recently has only one registered license in Dental Providers / Orthodontics and Dentofacial Orthopedics, which is considered as his primary health care specialty. Pridemore, Benjamin M can be contacted via phone (706) 234-0877.

Contact Information

Primary practice address
23 John Maddox Dr Nw Rome GA 30165-1413
Fax: (706) 232-5327
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X DN007095 Georgia

Profile Details

NPI number 1336153592
LBN Legal business name Pridemore, Benjamin M
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 27th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336153592 NPPES
Georgia Other DN007095 STATE LICENSE NUMBER

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