Provider Demographics
NPI:1457543803
Name:BENEDETTI, ANA DECASTRO (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:DECASTRO
Last Name:BENEDETTI
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5314 TERRACE ARBOR CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112
Mailing Address - Country:US
Mailing Address - Phone:305-345-1425
Mailing Address - Fax:
Practice Address - Street 1:2626 E COMMERCIAL BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4132
Practice Address - Country:US
Practice Address - Phone:954-771-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014115631223G0001X, 1223X0400X
FL175381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice