Healthcare Provider Details

I. General information

NPI: 1124683461
Provider Name (Legal Business Name): VANESSA BENAVENT, DDS, MSD, FAGD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 CLARKSVILLE SQUARE DR
CLARKSVILLE MD
21029-1856
US

IV. Provider business mailing address

5820 CLARKSVILLE SQUARE DR
CLARKSVILLE MD
21029-1856
US

V. Phone/Fax

Practice location:
  • Phone: 443-535-9600
  • Fax: 443-535-9601
Mailing address:
  • Phone: 443-535-9600
  • Fax: 443-535-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VANESSA BENAVENT ANDERSON
Title or Position: OWNER
Credential: DDS, MSD
Phone: 443-535-9600