Provider Demographics
NPI:1427586890
Name:HO, MICHAEL BENLI (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BENLI
Last Name:HO
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 1:601 E PICCADILLY DR APT 234
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5973
Mailing Address - Country:US
Mailing Address - Phone:847-641-0366
Mailing Address - Fax:
Practice Address - Street 1:13350 PACIFIC PL UNIT 2217
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-8227
Practice Address - Country:US
Practice Address - Phone:847-641-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345761223G0001X
390200000X
CA1034771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program