Provider Demographics
NPI:1093831109
Name:BENJAMIN, ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BENJAMIN
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 1:49 INDIAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3826
Mailing Address - Country:US
Mailing Address - Phone:914-948-0088
Mailing Address - Fax:
Practice Address - Street 1:7-11 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-3531
Practice Address - Country:US
Practice Address - Phone:914-290-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0338261223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics