Provider Demographics
NPI:1710651625
Name:MAVELIL, BENJAMIN GEORGE THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:GEORGE THOMAS
Last Name:MAVELIL
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 1:321 COURT ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2921
Mailing Address - Country:US
Mailing Address - Phone:276-451-2450
Mailing Address - Fax:
Practice Address - Street 1:321 COURT ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2921
Practice Address - Country:US
Practice Address - Phone:276-451-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014176211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice