1932487287 NPI number — TASHA DION BENJAMIN DDS

Table of content: TASHA DION BENJAMIN DDS (NPI 1932487287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932487287 NPI number — TASHA DION BENJAMIN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENJAMIN
Provider First Name:
TASHA
Provider Middle Name:
DION
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932487287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 JEFFERSON TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW IBERIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70560-5727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-365-4945
Provider Business Mailing Address Fax Number:
337-376-6860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 DERNIER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT MARTINVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70582-3809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-342-2566
Provider Business Practice Location Address Fax Number:
337-342-2533
Provider Enumeration Date:
08/03/2011

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: 1223G0001X , with the licence number:  6207 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1862070 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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