Provider Demographics
NPI:1225461247
Name:BENASSI, NATHANAEL DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHANAEL
Middle Name:DAVID
Last Name:BENASSI
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 1:8391 GREENWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3544
Mailing Address - Country:US
Mailing Address - Phone:608-535-9382
Mailing Address - Fax:
Practice Address - Street 1:8391 GREENWAY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3544
Practice Address - Country:US
Practice Address - Phone:815-979-3837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029572122300000X
WI10023481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019-029572OtherIL STATE DENTAL LICENSE