Provider Demographics
NPI:1457589293
Name:PYATT, BENSON THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENSON
Middle Name:THOMAS
Last Name:PYATT
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 1:1006 SOUTH ASH
Mailing Address - Street 2:PO BX 707
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622
Mailing Address - Country:US
Mailing Address - Phone:417-345-2793
Mailing Address - Fax:
Practice Address - Street 1:1006 SOUTH ASH
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622
Practice Address - Country:US
Practice Address - Phone:417-345-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009015903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist