Provider Demographics
NPI:1912072695
Name:BENJAMIN, RITA T (DDS)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:T
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:RITA
Other - Middle Name:T
Other - Last Name:LOSSAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:830 E RAND RD
Mailing Address - Street 2:UNIT 8
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-394-9440
Mailing Address - Fax:
Practice Address - Street 1:830 E RAND RD
Practice Address - Street 2:UNIT 8
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:847-394-9440
Practice Address - Fax:847-394-1660
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist