1679550602 NPI number — DAVID ANDERSON BENNION DMD MS

Table of content: DAVID ANDERSON BENNION DMD MS (NPI 1679550602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679550602 NPI number — DAVID ANDERSON BENNION DMD MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNION
Provider First Name:
DAVID
Provider Middle Name:
ANDERSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENNION
Provider Other First Name:
ANDY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD MS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1679550602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2233-A WILLAMETTE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-687-1151
Provider Business Mailing Address Fax Number:
541-345-0126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2233-A WILLAMETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-687-1151
Provider Business Practice Location Address Fax Number:
541-345-0126
Provider Enumeration Date:
12/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  D7367 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: D7367 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)