Healthcare Provider Details

I. General information

NPI: 1902430903
Provider Name (Legal Business Name): MICHAEL ISAAC BENICHOU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CROMWELL PL
WHITE PLAINS NY
10601-5006
US

IV. Provider business mailing address

2000 LINWOOD AVE APT 23V
FORT LEE NJ
07024-3015
US

V. Phone/Fax

Practice location:
  • Phone: 914-761-4567
  • Fax:
Mailing address:
  • Phone: 201-783-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number065311
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI03132800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2024047430
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: