Provider Demographics
NPI:1790899490
Name:JOHN J. BENINATO, D.D.S., P.C.
Entity Type:Organization
Organization Name:JOHN J. BENINATO, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENINATO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-234-0718
Mailing Address - Street 1:21 JOHN MADDOX DR NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1413
Mailing Address - Country:US
Mailing Address - Phone:706-234-0718
Mailing Address - Fax:
Practice Address - Street 1:21 JOHN MADDOX DR NW
Practice Address - Street 2:SUITE B
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1413
Practice Address - Country:US
Practice Address - Phone:706-234-0718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10834261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU13518Medicare UPIN
GA19NCBZSMedicare ID - Type Unspecified