Provider Demographics
NPI:1306000518
Name:THOMAS, BENJAMIN LAVARN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LAVARN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 COUNTRY CLUB RD STE C150
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2359
Mailing Address - Country:US
Mailing Address - Phone:541-484-1235
Mailing Address - Fax:541-431-0212
Practice Address - Street 1:895 COUNTRY CLUB RD STE C150
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2359
Practice Address - Country:US
Practice Address - Phone:541-484-1235
Practice Address - Fax:541-431-0212
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORD9134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program