Provider Demographics
NPI:1154706836
Name:BENAVIDES, ROBERTO ADRIAN (DDS)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ADRIAN
Last Name:BENAVIDES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7458 LOUIS PASTEUR DR APT 711
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4518
Mailing Address - Country:US
Mailing Address - Phone:210-427-9745
Mailing Address - Fax:
Practice Address - Street 1:9234 N LOOP 1604 W STE 121&123
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2983
Practice Address - Country:US
Practice Address - Phone:210-681-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX312971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice