Provider Demographics
NPI:1821000472
Name:BENITEZ, ROBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:BENITEZ
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 1:1620 HIGHWAY A1A
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-5427
Mailing Address - Country:US
Mailing Address - Phone:321-779-1411
Mailing Address - Fax:321-779-4456
Practice Address - Street 1:1620 HIGHWAY A1A
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-5427
Practice Address - Country:US
Practice Address - Phone:321-779-1411
Practice Address - Fax:321-779-4456
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice