Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 6780 | NE |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6780 | NE |
N | 1223S0112X | Oral and Maxillofacial Surgeon | PRV-TP-111-09 | MS |
N | 204E00000X | Oral & Maxillofacial Surgeon | T-2530 | MS |
NPI | 1073775839 |
---|---|
Provider Name | Dr. Benjamin James Anderson |
First Address | Omaha, NE 68116-2261 |
Second Address | Omaha, NE 68154-1950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2008 |
Last Update Date | 30/11/2016 |