Healthcare Provider Details

I. General information

NPI: 1821890583
Provider Name (Legal Business Name): MOISES BENITEZ - MARTINEZ REG DENTAL HYGIENIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 12TH AVE S STE 401
SEATTLE WA
98144-2730
US

IV. Provider business mailing address

1200 12TH AVE S STE 901
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-548-5850
  • Fax:
Mailing address:
  • Phone: 206-548-3114
  • Fax: 206-962-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH61308887
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: