Provider Demographics
NPI:1447706122
Name:CHIOU, BENJAMIN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:CHIOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 E VINEDO LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1459
Mailing Address - Country:US
Mailing Address - Phone:480-246-6849
Mailing Address - Fax:
Practice Address - Street 1:4803 E RAY RD
Practice Address - Street 2:P002C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6496
Practice Address - Country:US
Practice Address - Phone:480-755-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0095831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics