Provider Demographics
NPI:1508925033
Name:LEAVER, BENJAMIN DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DAVID
Last Name:LEAVER
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 1:1163 SHADOWRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037
Mailing Address - Country:US
Mailing Address - Phone:801-451-7812
Mailing Address - Fax:801-451-8962
Practice Address - Street 1:1466 N HIGHWAY 89
Practice Address - Street 2:SUITE 200
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2738
Practice Address - Country:US
Practice Address - Phone:801-451-7812
Practice Address - Fax:801-451-8962
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5351245-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice