Provider Demographics
NPI:1760583215
Name:DIBENEDETTO, ARMAND M (DDS)
Entity Type:Individual
Prefix:
First Name:ARMAND
Middle Name:M
Last Name:DIBENEDETTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 E HATTENDORF AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-1512
Mailing Address - Country:US
Mailing Address - Phone:630-529-1999
Mailing Address - Fax:
Practice Address - Street 1:57 E HATTENDORF AVE STE 150
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-1512
Practice Address - Country:US
Practice Address - Phone:630-529-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist