Provider Demographics
NPI:1699187203
Name:JAMO, BENJAMIN STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:STEVEN
Last Name:JAMO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 W LAKE LANSING RD STE 200
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8486
Mailing Address - Country:US
Mailing Address - Phone:517-339-1012
Mailing Address - Fax:
Practice Address - Street 1:335 W LAKE LANSING RD STE 200
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8486
Practice Address - Country:US
Practice Address - Phone:517-339-1012
Practice Address - Fax:517-339-0642
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-30
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist