Provider Demographics
NPI:1922034719
Name:DRS. LUTINS & BENITEZ, P.A.
Entity Type:Organization
Organization Name:DRS. LUTINS & BENITEZ, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-379-8377
Mailing Address - Street 1:301 E WENDOVER AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1207
Mailing Address - Country:US
Mailing Address - Phone:336-379-8377
Mailing Address - Fax:336-275-2078
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1207
Practice Address - Country:US
Practice Address - Phone:336-379-8377
Practice Address - Fax:336-275-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty