Provider Demographics
NPI:1063639714
Name:BENEDETTO, LYNDA JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:JANE
Last Name:BENEDETTO
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 1:1165 COAST VILLAGE RD STE I
Mailing Address - Street 2:
Mailing Address - City:MONTECITO
Mailing Address - State:CA
Mailing Address - Zip Code:93108-3769
Mailing Address - Country:US
Mailing Address - Phone:805-565-9837
Mailing Address - Fax:805-565-9831
Practice Address - Street 1:1165 COAST VILLAGE RD STE I
Practice Address - Street 2:
Practice Address - City:MONTECITO
Practice Address - State:CA
Practice Address - Zip Code:93108-3769
Practice Address - Country:US
Practice Address - Phone:805-565-9837
Practice Address - Fax:805-565-9831
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice