Healthcare Provider Details

I. General information

NPI: 1922034719
Provider Name (Legal Business Name): DRS. LUTINS & BENITEZ, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE SUITE 315
GREENSBORO NC
27401-1207
US

IV. Provider business mailing address

301 E WENDOVER AVE SUITE 315
GREENSBORO NC
27401-1207
US

V. Phone/Fax

Practice location:
  • Phone: 336-379-8377
  • Fax: 336-275-2078
Mailing address:
  • Phone: 336-379-8377
  • Fax: 336-275-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0502
License Number StateNC

VIII. Authorized Official

Name: MRS. BRENDA P. ROBINSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 336-379-8377