Individual
DR. BENJAMIN GRAHAM BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
338 S DAKOTA AVE BLDG 13850, VANDENBERG AFB, CA 93437-6307
(361) 815-9929
Mailing address
817 BASS LANDING PL, GREENSBORO, NC 27455-3440
(361) 815-9299
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10867252-9921
UT
1223G0001X
General Practice Dentistry
Primary
12605
NC
Other
Enumeration date
05/02/2018
Last updated
07/27/2025
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