Provider Demographics
NPI:1265762199
Name:BENO, ADAM M (DMD, PA)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:M
Last Name:BENO
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:ADAM
Other - Middle Name:M
Other - Last Name:BENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, PA
Mailing Address - Street 1:13691 METRO PKWY
Mailing Address - Street 2:STE 250
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4350
Mailing Address - Country:US
Mailing Address - Phone:239-768-5900
Mailing Address - Fax:239-768-5977
Practice Address - Street 1:13691 METRO PKWY
Practice Address - Street 2:STE 250
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4350
Practice Address - Country:US
Practice Address - Phone:239-768-5900
Practice Address - Fax:239-768-5977
Is Sole Proprietor?:No
Enumeration Date:2009-12-25
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN189101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice