Provider Demographics
NPI:1013058460
Name:BENNAMARK DENTAL PC
Entity Type:Organization
Organization Name:BENNAMARK DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:B
Authorized Official - Last Name:RUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-743-2544
Mailing Address - Street 1:2300 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645
Mailing Address - Country:US
Mailing Address - Phone:773-743-2544
Mailing Address - Fax:773-743-2574
Practice Address - Street 1:2300 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645
Practice Address - Country:US
Practice Address - Phone:773-743-2544
Practice Address - Fax:773-743-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty