Provider Demographics
NPI:1033617006
Name:BENSHETRIT, ABRAHAM
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:BENSHETRIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8209 LAGOON DR
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-1618
Mailing Address - Country:US
Mailing Address - Phone:609-517-1729
Mailing Address - Fax:
Practice Address - Street 1:616 AVENUE OF THE STATES
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-4215
Practice Address - Country:US
Practice Address - Phone:610-874-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-10-25
Deactivation Date:2018-04-11
Deactivation Code:
Reactivation Date:2018-10-25
Provider Licenses
StateLicense IDTaxonomies
PADS0415911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice