Provider Demographics
NPI:1750505046
Name:CONTRERAS, BENJAMIN F (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:F
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-5802
Mailing Address - Country:US
Mailing Address - Phone:713-906-7901
Mailing Address - Fax:
Practice Address - Street 1:1027 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506-4538
Practice Address - Country:US
Practice Address - Phone:713-472-8419
Practice Address - Fax:713-472-0344
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1350506-01Medicaid