Provider Demographics
NPI:1437216512
Name:DUVAL, BENJAMIN THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:THOMAS
Last Name:DUVAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 E 65TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4421
Mailing Address - Country:US
Mailing Address - Phone:912-352-4867
Mailing Address - Fax:912-352-4860
Practice Address - Street 1:835 E 65TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4421
Practice Address - Country:US
Practice Address - Phone:912-352-4867
Practice Address - Fax:912-352-4860
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0120251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics