Provider Demographics
NPI:1831967199
Name:BENBELLA, HOCINE AMIM (DMD)
Entity type:Individual
Prefix:
First Name:HOCINE
Middle Name:AMIM
Last Name:BENBELLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 SARDINIA CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6072
Mailing Address - Country:US
Mailing Address - Phone:310-593-1468
Mailing Address - Fax:
Practice Address - Street 1:2 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3124
Practice Address - Country:US
Practice Address - Phone:530-894-9044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS108480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist