Provider Demographics
NPI:1508965245
Name:BENEDETTO, ANDREW MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MICHAEL
Last Name:BENEDETTO
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 1:858 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-1955
Mailing Address - Country:US
Mailing Address - Phone:626-930-0156
Mailing Address - Fax:626-930-0196
Practice Address - Street 1:858 W FOOTHILL BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-1955
Practice Address - Country:US
Practice Address - Phone:626-930-0156
Practice Address - Fax:626-930-0196
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA339071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice