Provider Demographics
NPI:1255590352
Name:BENWARE, JOHN T JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:BENWARE
Suffix:JR
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 1:52 CONKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-1834
Mailing Address - Country:US
Mailing Address - Phone:607-722-6985
Mailing Address - Fax:607-726-7083
Practice Address - Street 1:52 CONKLIN AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1834
Practice Address - Country:US
Practice Address - Phone:607-722-6985
Practice Address - Fax:607-723-7083
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist