Provider Demographics
NPI:1851743090
Name:BENYAMMI, BRIAN MALEK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MALEK
Last Name:BENYAMMI
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 1:777 CUESTA DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3771
Mailing Address - Country:US
Mailing Address - Phone:650-254-1596
Mailing Address - Fax:650-254-0738
Practice Address - Street 1:777 CUESTA DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3771
Practice Address - Country:US
Practice Address - Phone:650-254-1596
Practice Address - Fax:650-254-0738
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist