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General NPI Number Information
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NPI Number | 1700470226
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Entity Type | Individual
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Provider Name | BENJAMIN VAVRA DDS
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Gender | Male
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | ELK RIVER FAMILY DENTISTRY 303 MAIN ST NW
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City | ELK RIVER
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State | MN
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Zip | 55330
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Country | US
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Telephone | 734-441-9181
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Fax |
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Provider Business Mailing Address
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Address Line | JACOBI MEDICAL CENTER 1400 PELHAM PARKWAY SOUTH
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City | BRONX
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State | NY
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Zip | 10461
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Country | US
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Telephone |
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Fax |
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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 | D14698
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License Number State | MN
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