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General NPI Number Information
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NPI Number | 1396152138
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Entity Type | Individual
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Provider Name | JACQUELINE FE BENITO DMD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 1111 24TH ST STE 201
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City | SACRAMENTO
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State | CA
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Zip | 95816-5019
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Country | US
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Telephone | 916-442-5228
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Fax |
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Provider Business Mailing Address
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Address Line | 8391 QUAIL PEAK COURT
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City | ELK GROVE
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State | CA
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Zip | 95758
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Country | US
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Telephone | 916-806-9621
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 63602
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License Number State | CA
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