Benjamin T Gallion, DDS
Individual provider Active NPI Dentist · Aurora, MO
NPI 1770964116 · NPPES record last updated Aug 19, 2019
Key facts
- NPI
- 1770964116
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2015016955 (MO)
- Practice address
- 1402 S Elliott Ave Ste a
Aurora, MO 65605-2154 - Phone
- (417) 678-5958
- Fax
- (417) 678-1519
- NPI assigned
- Jun 11, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150707001065 | MO | Order and Referring Only - Dentist |
0749592632 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015016955 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jump Dental, LLC | Past | Accepting new patients | |
| Dr. Donald R. Jump DDS Inc PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2015016955 | MO | Yes |
Addresses
Primary practice location
1402 S Elliott Ave Ste a
Aurora, MO 65605-2154
Mailing address
1402 S Elliott Ave Ste a
Aurora, MO 65605-2154
Phone (417) 678-5958
Other providers in Aurora, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.