Healthcare Provider Details

I. General information

NPI: 1396742615
Provider Name (Legal Business Name): HOWARD W. BENATOVICH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

1281 UNION RD
WEST SENECA NY
14224-2900
US

IV. Provider business mailing address

1281 UNION RD
WEST SENECA NY
14224-2900
US

V. Phone/Fax

Practice location:
  • Phone: 716-675-5166
  • Fax: 716-675-5167
Mailing address:
  • Phone: 716-675-5166
  • Fax: 716-675-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number27403
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: