Healthcare Provider Details

I. General information

NPI: 1528210853
Provider Name (Legal Business Name): BENOY KANNIKATTEL GEORGE BDS, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 FREEMAN DRIVE C 100
CHARLOTTE NC
28273
US

IV. Provider business mailing address

8334 PINEVILLE MATTHEWS RD UNIT 103-198
CHARLOTTE NC
28226-3774
US

V. Phone/Fax

Practice location:
  • Phone: 980-580-4271
  • Fax:
Mailing address:
  • Phone: 631-487-5895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10839
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number10456
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9936
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: