Benjamin Bennett Waites, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

35263 Issued in TX

Practice address

937 Bryden Ave
Lewiston, ID 83507

Phone

(208) 746-2668

Fax

(208) 746-7413

NPI assigned

Jun 23, 2019

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Two Rivers Family Dentistry

  • Dental Clinic/Center
  • Lewiston, ID
  • NPI 1770165854
  NPD Authorized official
• W & H Enterprises

  • Dentist
  • Peralta, NM
  • NPI 1457193054
  NPD (past) Authorized official

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

{
    "created_epoch": "1561248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632268800000",
    "number": "1427619238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "937 BRYDEN AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "83507",
            "telephone_number": "208-746-2668",
            "fax_number": "208-746-7413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "937 BRYDEN AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "83507",
            "telephone_number": "208-746-2668",
            "fax_number": "208-746-7413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAITES",
        "first_name": "BENJAMIN",
        "middle_name": "BENNETT",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-23",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "35263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Odessa",
            "affiliation": "N",
            "address_1": "4901 E 42nd St Ste B",
            "city": "Odessa",
            "state": "TX",
            "country_code": "US",
            "postal_code": "797627338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Roger D Virgin
• Edward Angus Vivian, MD
• Elizabeth L Von Bargen, NP
• James F Waham, PCPRC
• William Wainwright, DPT
• Robert Alan Wales, MD, FACC
• Walgreen Co (Walgreens #02679)
• Walgreen Co (Rite Aid #16585)
• Walgreens
• Walla Walla Vamc

• General Practice Dentistry in Lewiston, ID
• Providers in Lewiston, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.