Provider Demographics
NPI:1033494729
Name:BENICHOU, LIORA (DDS)
Entity Type:Individual
Prefix:
First Name:LIORA
Middle Name:
Last Name:BENICHOU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 57TH ST
Mailing Address - Street 2:APT#9B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2928
Mailing Address - Country:US
Mailing Address - Phone:646-321-8994
Mailing Address - Fax:
Practice Address - Street 1:300 E 57TH ST
Practice Address - Street 2:APT#9B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2928
Practice Address - Country:US
Practice Address - Phone:646-321-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055857-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry