MEDICARE: THOMAS E BENJAMIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D0620	SD

General Provider Information

NPI Number	:	1508081324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS E BENJAMIN DDS

Provider Business Mailing Address
First Line	:	2620 JACKSON BLVD STE B
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3478
Country	:	US
Telephone Number	:	605-348-1712
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 JACKSON BLVD STE B
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3478
Country	:	US
Telephone Number	:	605-348-1712
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	08/15/2024

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