Provider Demographics
NPI:1083988307
Name:BENJAMIN F CONTRERAS
Entity type:Organization
Organization Name:BENJAMIN F CONTRERAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-472-8419
Mailing Address - Street 1:1027 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506-4500
Mailing Address - Country:US
Mailing Address - Phone:713-472-8419
Mailing Address - Fax:713-472-0344
Practice Address - Street 1:1027 MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506
Practice Address - Country:US
Practice Address - Phone:713-472-8419
Practice Address - Fax:713-472-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty