Provider Demographics
NPI:1508081324
Name:BENJAMIN, THOMAS E (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:BENJAMIN
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 1:2620 JACKSON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3478
Mailing Address - Country:US
Mailing Address - Phone:605-348-1712
Mailing Address - Fax:
Practice Address - Street 1:2620 JACKSON BLVD STE B
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3478
Practice Address - Country:US
Practice Address - Phone:605-348-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD06201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice