Provider Demographics
NPI:1619993862
Name:LASHLEY, BENJAMIN ALLEN (DD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ALLEN
Last Name:LASHLEY
Suffix:
Gender:M
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 N MALONEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-8901
Mailing Address - Country:US
Mailing Address - Phone:308-534-8648
Mailing Address - Fax:
Practice Address - Street 1:805 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5282
Practice Address - Country:US
Practice Address - Phone:308-534-1289
Practice Address - Fax:308-534-1530
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083097400Medicaid