Provider Demographics
NPI:1326032988
Name:BENIVEGNA, VINCENT VERN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:VERN
Last Name:BENIVEGNA
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 1:325 W LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8524
Mailing Address - Country:US
Mailing Address - Phone:517-337-9759
Mailing Address - Fax:517-337-8156
Practice Address - Street 1:325 W LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8524
Practice Address - Country:US
Practice Address - Phone:517-337-9759
Practice Address - Fax:517-337-8156
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010155851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-3360161Medicaid
MI10-3360161Medicaid