Provider Demographics
NPI:1891827275
Name:BENITEZ, MILDRED (DMD)
Entity type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:
Last Name:BENITEZ
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:PO BOX 1807
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1807
Mailing Address - Country:US
Mailing Address - Phone:787-739-8063
Mailing Address - Fax:787-739-8063
Practice Address - Street 1:18 CALLE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3366
Practice Address - Country:US
Practice Address - Phone:787-739-8063
Practice Address - Fax:787-739-8063
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660661411OtherEIN