Provider Demographics
NPI:1235386251
Name:BENHAMOU, TRACY DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:DANIEL
Last Name:BENHAMOU
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 1:62 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1333
Mailing Address - Country:US
Mailing Address - Phone:925-634-9237
Mailing Address - Fax:925-634-9238
Practice Address - Street 1:62 OAK ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1333
Practice Address - Country:US
Practice Address - Phone:925-634-9237
Practice Address - Fax:925-634-9238
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice