Provider Demographics
NPI:1851311468
Name:BENJAMIN, HIBRET HAILU (DDS)
Entity type:Individual
Prefix:DR
First Name:HIBRET
Middle Name:HAILU
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 DEL ORO LAGOON # 2
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5333
Mailing Address - Country:US
Mailing Address - Phone:415-218-2483
Mailing Address - Fax:650-755-2882
Practice Address - Street 1:2001 UNION ST STE 590
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4125
Practice Address - Country:US
Practice Address - Phone:415-409-3368
Practice Address - Fax:415-409-3370
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA501391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice