Healthcare Provider Details

I. General information

NPI: 1023943156
Provider Name (Legal Business Name): SARAMMA BENN THOMAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E FOOTHILLS DR # 710A
NEWBERG OR
97132-6124
US

IV. Provider business mailing address

4420 E JORY ST APT 114
NEWBERG OR
97132-3661
US

V. Phone/Fax

Practice location:
  • Phone: 503-379-0294
  • Fax:
Mailing address:
  • Phone: 503-379-0294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD8467
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: