Healthcare Provider Details

I. General information

NPI: 1841413218
Provider Name (Legal Business Name): FRED WILLIAM BENENATI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1214
US

IV. Provider business mailing address

1201 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1214
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5550
  • Fax: 405-271-3006
Mailing address:
  • Phone: 405-271-5550
  • Fax: 405-271-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3902
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: