Healthcare Provider Details

I. General information

NPI: 1821000472
Provider Name (Legal Business Name): ROBERTO BENITEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 HIGHWAY A1A
SATELLITE BEACH FL
32937-5427
US

IV. Provider business mailing address

1620 HIGHWAY A1A
SATELLITE BEACH FL
32937-5427
US

V. Phone/Fax

Practice location:
  • Phone: 321-779-1411
  • Fax: 321-779-4456
Mailing address:
  • Phone: 321-779-1411
  • Fax: 321-779-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN15627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: