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General NPI Number Information
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NPI Number | 1508925033
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Entity Type | Individual
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Provider Name | BENJAMIN DAVID LEAVER DMD
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Gender | Male
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1466 N HIGHWAY 89 SUITE 200
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City | FARMINGTON
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State | UT
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Zip | 84025-2738
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Country | US
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Telephone | 801-451-7812
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Fax | 801-451-8962
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Provider Business Mailing Address
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Address Line | 1163 SHADOWRIDGE DRIVE
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City | KAYSVILLE
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State | UT
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Zip | 84037
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Country | US
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Telephone | 801-451-7812
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Fax | 801-451-8962
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5351245-9922
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License Number State | UT
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