Provider Demographics
NPI:1578568598
Name:BENITEZ, CARLOS F (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:F
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 AVE TITO CASTRO
Mailing Address - Street 2:PMB 349
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0206
Mailing Address - Country:US
Mailing Address - Phone:787-841-1419
Mailing Address - Fax:787-841-1419
Practice Address - Street 1:609 AVE TITO CASTRO
Practice Address - Street 2:PMB 349
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0206
Practice Address - Country:US
Practice Address - Phone:787-841-1419
Practice Address - Fax:787-841-1419
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR41573OtherSSS
PR041348OtherBLUE CROSS
PR206384OtherUTI
PR7310230OtherHUMANA