Provider Demographics
NPI:1407143472
Name:BENAVIDES, LUZ (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1706
Mailing Address - Country:US
Mailing Address - Phone:201-836-5333
Mailing Address - Fax:201-836-1991
Practice Address - Street 1:780 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1706
Practice Address - Country:US
Practice Address - Phone:201-836-5333
Practice Address - Fax:201-836-1991
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02474700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist