Provider Demographics
NPI:1932836988
Name:TAGHVAEI, BENYAMIN (DMD)
Entity Type:Individual
Prefix:
First Name:BENYAMIN
Middle Name:
Last Name:TAGHVAEI
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 1:401 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44407 CHALLENGER WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-3237
Practice Address - Country:US
Practice Address - Phone:703-424-5816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2023-11-29
Deactivation Date:2023-11-06
Deactivation Code:
Reactivation Date:2023-11-20
Provider Licenses
StateLicense IDTaxonomies
PADS043818122300000X
CA109575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty