Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0023616 | TX |
N | 1223G0001X | General Practice | 0023616 | TX |
N | 213EG0000X | General Practice | 0023616 | TX |
Y | 1223X0400X | Orthodontists | 0023616 | TX |
NPI | 1043408735 |
---|---|
Provider Name | Dr. Benito Jose Benitez |
First Address | Dallas, TX 75231-4005 |
Second Address | Dallas, TX 75243-7699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 23/02/2015 |