Healthcare Provider Details

I. General information

NPI: 1508711516
Provider Name (Legal Business Name): DANIEL VALMIR BENVENUTO DA COSTA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 E CAMELBACK RD STE 110
PHOENIX AZ
85016-4136
US

IV. Provider business mailing address

8203 W ORAIBI DR APT 2133
PEORIA AZ
85382-6602
US

V. Phone/Fax

Practice location:
  • Phone: 602-833-2564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: