Provider Demographics
NPI:1851325757
Name:BENN, RENRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENRICK
Middle Name:
Last Name:BENN
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 1:4 METROTECH CENTER
Mailing Address - Street 2:LOBBY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-403-0700
Mailing Address - Fax:718-403-0441
Practice Address - Street 1:4 METROTECH CENTER
Practice Address - Street 2:LOBBY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-403-0700
Practice Address - Fax:718-403-0441
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY407001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01549137Medicaid