Provider Demographics
NPI:1720095078
Name:BENESH, MARK LAMONTE (DMD MBA)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LAMONTE
Last Name:BENESH
Suffix:
Gender:M
Credentials:DMD MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-1843
Mailing Address - Country:US
Mailing Address - Phone:585-544-2225
Mailing Address - Fax:585-544-3679
Practice Address - Street 1:3429 CULVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-1843
Practice Address - Country:US
Practice Address - Phone:585-544-2225
Practice Address - Fax:585-544-3679
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0317311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice