Provider Demographics
NPI:1043408735
Name:BENITEZ, BENITO JOSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENITO
Middle Name:JOSE
Last Name:BENITEZ
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 1:9109 DRUMCLIFFE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4005
Mailing Address - Country:US
Mailing Address - Phone:214-208-7759
Mailing Address - Fax:
Practice Address - Street 1:8510 ABRAMS RD
Practice Address - Street 2:STE. 508
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7699
Practice Address - Country:US
Practice Address - Phone:214-503-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00236161223X0400X, 122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice