Provider Demographics
NPI:1568511533
Name:BENVENISTE, RICHARD (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:BENVENISTE
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19231 VICTORY BLVD
Mailing Address - Street 2:#256
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6347
Mailing Address - Country:US
Mailing Address - Phone:818-881-7337
Mailing Address - Fax:818-881-6183
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:#256
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6347
Practice Address - Country:US
Practice Address - Phone:818-881-7337
Practice Address - Fax:818-881-6183
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist