Provider Demographics
NPI:1508977281
Name:GALLERIA DENTISTRY LEGACY LLC
Entity Type:Organization
Organization Name:GALLERIA DENTISTRY LEGACY LLC
Other - Org Name:GALLERIA DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:ANN YANDA
Authorized Official - Last Name:BENZA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-592-5112
Mailing Address - Street 1:9140 GALLERIA COURT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109
Mailing Address - Country:US
Mailing Address - Phone:239-592-5112
Mailing Address - Fax:239-592-0254
Practice Address - Street 1:9140 GALLERIA COURT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109
Practice Address - Country:US
Practice Address - Phone:239-592-5112
Practice Address - Fax:239-592-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN90621223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1316322134OtherNPI
FL1467837278OtherNPI
FL1083725758OtherNPI