Provider Demographics
NPI:1699746883
Name:BENITEZ, LUIS M (DMD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:M
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:LUIS
Other - Middle Name:M
Other - Last Name:BENITEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:301 E WENDOVER AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1230
Mailing Address - Country:US
Mailing Address - Phone:336-379-8377
Mailing Address - Fax:336-275-2078
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-379-8377
Practice Address - Fax:336-275-2078
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics