Provider Demographics
NPI:1114657566
Name:BENITEZ, ANDREA MARIA
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIA
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ALHAMBRA PLZ STE 25
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5216
Mailing Address - Country:US
Mailing Address - Phone:786-507-4440
Mailing Address - Fax:
Practice Address - Street 1:1 ALHAMBRA PLZ STE 25
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5216
Practice Address - Country:US
Practice Address - Phone:786-507-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN27262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program