Benjamin Lorenzo Gardea Jr., D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D008065 Issued in AZ

Practice address

2016 W 16TH St
Safford, AZ 85546-4026

Phone

(928) 428-1500

NPI assigned

Aug 17, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• BLG Dental PLLC

  • General Practice Dentistry
  • Tucson, AZ
  • NPI 1518563139
  NPD Authorized official
• Tempe Dental Partners LLC

  • General Practice Dentistry
  • Tempe, AZ
  • NPI 1154186450
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309478400000",
    "number": "1417262247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1625",
            "city": "PAGE",
            "state": "AZ",
            "postal_code": "860401625",
            "telephone_number": "928-645-9675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2016 W 16TH ST",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855464026",
            "telephone_number": "928-428-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDEA",
        "first_name": "BENJAMIN",
        "middle_name": "LORENZO",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-17",
        "last_updated": "2011-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D008065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trisha Boyer French, PHARM.D.
• Amy M Fulps, RDH
• Anita Garcia, RN
• Dana M Garcia, PA
• Marvin Raul Garcia, PA-C
• Charles J Gardner, PA-C
• Robert L Garrett, O.D.
• Leslie R Garwood, RN
• Gary L. Muncy M.D., P.C.
• Daniel Leroy Gibbons, OTD, OTR/L

• General Practice Dentistry in Safford, AZ
• Providers in Safford, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.