Healthcare Provider Details

I. General information

NPI: 1588843528
Provider Name (Legal Business Name): KAREN BENITEZ D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 GREYROCK PL
STAMFORD CT
06901-3100
US

IV. Provider business mailing address

1661 YORK AVE APT 6H
NEW YORK NY
10128-6567
US

V. Phone/Fax

Practice location:
  • Phone: 203-323-5439
  • Fax:
Mailing address:
  • Phone: 816-305-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number053667-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number053667-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number010057
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: