Healthcare Provider Details

I. General information

NPI: 1568272045
Provider Name (Legal Business Name): ANA KAREN BENCOSME DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EASTON RD STE 315
WYNCOTE PA
19095-2900
US

IV. Provider business mailing address

1528 WALNUT ST STE 1802
PHILADELPHIA PA
19102-3612
US

V. Phone/Fax

Practice location:
  • Phone: 267-631-1000
  • Fax:
Mailing address:
  • Phone: 267-810-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number42024
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03122100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS045428
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: