Provider Demographics
NPI:1083915664
Name:BENBASSAT DENTAL CORPORATION
Entity Type:Organization
Organization Name:BENBASSAT DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENBASSAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,
Authorized Official - Phone:949-863-9620
Mailing Address - Street 1:20062 SW BIRCH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1518
Mailing Address - Country:US
Mailing Address - Phone:949-863-9620
Mailing Address - Fax:949-271-4931
Practice Address - Street 1:4520 EXECUTIVE DR STE 340
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3020
Practice Address - Country:US
Practice Address - Phone:858-677-0661
Practice Address - Fax:949-271-4931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty