Provider Demographics
NPI:1891237285
Name:ANTHONY F BENASSI DDS LLC
Entity Type:Organization
Organization Name:ANTHONY F BENASSI DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BENASSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-397-2752
Mailing Address - Street 1:735 N PERRYVILLE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6236
Mailing Address - Country:US
Mailing Address - Phone:815-397-2752
Mailing Address - Fax:815-397-2759
Practice Address - Street 1:735 N PERRYVILLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6236
Practice Address - Country:US
Practice Address - Phone:815-397-2752
Practice Address - Fax:815-397-2759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190232031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty