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General NPI Number Information
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NPI Number | 1538424585
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Entity Type | Organization
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Legal Business Name | BENEDETTI ORTHODONTICS PA
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 2626 E COMMERCIAL BLVD # 101
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4132
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Country | US
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Telephone | 954-771-0902
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Fax |
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Provider Business Mailing Address
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Address Line | 2626 E COMMERCIAL BLVD # 101
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4132
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Country | US
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Telephone | 954-771-0902
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANA BENEDETTI
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Credential | DMD, MSD
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Telephone | 954-771-0902
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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 | DN17538
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License Number State | FL
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