Individual
DR. BENJAMIN BENNETT WAITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
937 BRYDEN AVE, LEWISTON, ID 83507
(208) 746-2668
(208) 746-7413
Mailing address
937 BRYDEN AVE, LEWISTON, ID 83507
(208) 746-2668
(208) 746-7413
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
35263
TX
Other
Enumeration date
06/23/2019
Last updated
09/22/2021
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