Provider Demographics
NPI:1699773036
Name:BENEDICTO, SOCORRO AMAGO (DMD)
Entity type:Individual
Prefix:
First Name:SOCORRO
Middle Name:AMAGO
Last Name:BENEDICTO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 149TH PL
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4942
Mailing Address - Country:US
Mailing Address - Phone:718-939-4027
Mailing Address - Fax:718-939-4121
Practice Address - Street 1:4017 149TH PL
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4942
Practice Address - Country:US
Practice Address - Phone:718-939-4027
Practice Address - Fax:718-939-4121
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry