Provider Demographics
NPI:1033837133
Name:ORMOND FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:ORMOND FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:BENCHIMOL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-397-1452
Mailing Address - Street 1:8495 TWIN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1923
Mailing Address - Country:US
Mailing Address - Phone:954-397-1452
Mailing Address - Fax:
Practice Address - Street 1:1200 W GRANADA BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8157
Practice Address - Country:US
Practice Address - Phone:386-275-1792
Practice Address - Fax:386-265-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental