Provider Demographics
NPI:1205832516
Name:RELIS, BENJAMIN I (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:I
Last Name:RELIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2654
Mailing Address - Country:US
Mailing Address - Phone:412-681-4003
Mailing Address - Fax:412-687-6941
Practice Address - Street 1:4415 5TH AVE
Practice Address - Street 2:WEBSTER HALL 3RD FL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2654
Practice Address - Country:US
Practice Address - Phone:412-681-4003
Practice Address - Fax:412-687-6941
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019692-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice