Provider Demographics
NPI:1760629869
Name:BENJAMINI, MINDY JOY (MD)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:JOY
Last Name:BENJAMINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1541
Mailing Address - Country:US
Mailing Address - Phone:484-278-4737
Mailing Address - Fax:484-278-4736
Practice Address - Street 1:853 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:484-278-4737
Practice Address - Fax:484-278-4736
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031569L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice