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General NPI Number Information
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NPI Number | 1992963706
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Entity Type | Individual
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Provider Name | BENJAMIN JAMES LAGO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 1900 WHITES RD STE 3
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City | KALAMAZOO
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State | MI
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Zip | 49008-2872
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Country | US
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Telephone | 269-382-0482
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Fax | 269-382-2906
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Provider Business Mailing Address
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Address Line | 1900 WHITES RD STE 3
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City | KALAMAZOO
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State | MI
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Zip | 49008-2872
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Country | US
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Telephone | 269-382-0482
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Fax | 269-382-2906
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 9129
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2901019673
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License Number State | MI
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