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General NPI Number Information
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NPI Number | 1902169899
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Entity Type | Individual
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Provider Name | HARRY HERBERT BENAVENT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2012
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Last Update Date | 06/17/2012
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Provider Practice Location Address
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Address Line | 5820 CLARKSVILLE SQUARE DR
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1856
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Country | US
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Telephone | 443-535-9600
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Fax | 443-535-9601
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Provider Business Mailing Address
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Address Line | 7 N CALVERT ST APT 1101
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City | BALTIMORE
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State | MD
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Zip | 21202-2255
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Country | US
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Telephone | 410-746-3715
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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 | 15062
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License Number State | MD
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