Provider Demographics
NPI:1992282883
Name:BENAVIDES, ROBERTO JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:BENAVIDES
Suffix:JR
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 1:3521 MINA DE ORO
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-9581
Mailing Address - Country:US
Mailing Address - Phone:956-393-1064
Mailing Address - Fax:
Practice Address - Street 1:1214 DIXIELAND RD STE 4
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3314
Practice Address - Country:US
Practice Address - Phone:956-428-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice