Provider Demographics
NPI:1649483322
Name:BENCH, THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BENCH
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 1:171 ROUTE 37 E
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-5502
Mailing Address - Country:US
Mailing Address - Phone:732-557-5500
Mailing Address - Fax:732-557-5300
Practice Address - Street 1:171 ROUTE 37 E
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-5502
Practice Address - Country:US
Practice Address - Phone:732-557-5500
Practice Address - Fax:732-557-5300
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1184724965OtherATLANTIC DENTAL