Healthcare Provider Details

I. General information

NPI: 1326782913
Provider Name (Legal Business Name): BENI BANBAHJI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 N CLARK ST
CHICAGO IL
60626-3211
US

IV. Provider business mailing address

2833 W ESTES AVE
CHICAGO IL
60645-2903
US

V. Phone/Fax

Practice location:
  • Phone: 347-707-0907
  • Fax:
Mailing address:
  • Phone: 347-707-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number06366701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: