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General NPI Number Information
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NPI Number | 1124194394
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Entity Type | Individual
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Provider Name | THEODORE BENADERET DDS
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9900 MCFADDEN AVE STE 201
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City | WESTMINSTER
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State | CA
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Zip | 92683-6978
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Country | US
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Telephone | 714-531-2513
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Fax | 714-531-1603
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Provider Business Mailing Address
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Address Line | 9900 MCFADDEN AVE STE 201
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City | WESTMINSTER
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State | CA
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Zip | 92683-6978
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Country | US
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Telephone | 714-531-2513
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Fax | 714-531-1603
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 18786
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License Number State | CA
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