Individual provider Active NPI

Benjamin J Driver, DMD

  • General Practice Dentistry
  • Roseburg, OR
National Provider Identifier
1518251065
Registry record updated Jun 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9318 Issued in OR
Practice address
1651 NW Hughwood CT
Roseburg, OR 97471-8834
Phone
(541) 672-8187
Fax
(541) 672-0224
NPI assigned
Jun 1, 2011
Last updated
Jun 1, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D9318 OR Primary

Addresses

Primary practice location

1651 NW Hughwood CT
Roseburg, OR 97471-8834

Mailing address

299 Hidden Valley LN
Roseburg, OR 97471-8255
Phone (503) 956-1066

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160415001869 OR Order and Referring Only - DentistPractitioner - Dentist 6608174164

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D9318ORMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Mark R Driver DMD PC General Practice Past Accepting new patients
Driver & Driver PC, Dba Driver Dentistry General Practice PastSince Aug 2, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306886400000",
    "number": "1518251065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "299 HIDDEN VALLEY LN",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718255",
            "telephone_number": "503-956-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 NW HUGHWOOD CT",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718834",
            "telephone_number": "541-672-8187",
            "fax_number": "541-672-0224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRIVER",
        "first_name": "BENJAMIN",
        "middle_name": "J",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-01",
        "last_updated": "2011-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.