Provider Demographics
NPI:1467791954
Name:BENBASSAT, NISSIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:NISSIM
Middle Name:
Last Name:BENBASSAT
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 1:5916 N BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2630
Mailing Address - Country:US
Mailing Address - Phone:626-285-2702
Mailing Address - Fax:
Practice Address - Street 1:2155 WEBSTER ST
Practice Address - Street 2:SUITE 522
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2333
Practice Address - Country:US
Practice Address - Phone:415-929-6531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584211223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000714OtherUNIVERSITY OF THE PACIFIC FACULTY ID
CA58421OtherDENTAL LICENSE