Provider Demographics
NPI:1124683461
Name:VANESSA BENAVENT, DDS, MSD, FAGD
Entity type:Organization
Organization Name:VANESSA BENAVENT, DDS, MSD, FAGD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:BENAVENT
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:443-535-9600
Mailing Address - Street 1:5820 CLARKSVILLE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1856
Mailing Address - Country:US
Mailing Address - Phone:443-535-9600
Mailing Address - Fax:443-535-9601
Practice Address - Street 1:5820 CLARKSVILLE SQUARE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1856
Practice Address - Country:US
Practice Address - Phone:443-535-9600
Practice Address - Fax:443-535-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain