Provider Demographics
NPI:1528190881
Name:VIRGIL BENJAMIN DMD INC.
Entity Type:Organization
Organization Name:VIRGIL BENJAMIN DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-302-8515
Mailing Address - Street 1:32605 HIGHWAY 79 SOUTH
Mailing Address - Street 2:213
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-302-8515
Mailing Address - Fax:951-302-8057
Practice Address - Street 1:32605 HIGHWAY 79 SOUTH
Practice Address - Street 2:213
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-302-8515
Practice Address - Fax:951-302-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty