Provider Demographics
NPI:1154108678
Name:PALMETTO DENTAL STUDIO INC
Entity type:Organization
Organization Name:PALMETTO DENTAL STUDIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENAVIDES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-747-4763
Mailing Address - Street 1:7306 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1855
Mailing Address - Country:US
Mailing Address - Phone:786-747-4763
Mailing Address - Fax:305-290-3203
Practice Address - Street 1:7306 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1855
Practice Address - Country:US
Practice Address - Phone:786-747-4763
Practice Address - Fax:305-290-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty