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NPI Code Detail

MEDICARE: DR. DALE BENJAMIN DMD

MEDICARE: DR. DALE BENJAMIN DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist019028101IL

General Provider Information

NPI Number : 1003116617
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DALE BENJAMIN DMD
Provider Business Mailing Address
First Line : 2000 W HURON ST # 2
Second Line :
City : CHICAGO
State : IL
Zip : 60612-1304
Country : US
Telephone Number : 352-284-4164
Fax Number :
Provider Business Practice Location Address
First Line : 6020 W DIVERSEY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-1108
Country : US
Telephone Number : 773-237-0707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2010
Last Update Date : 10/28/2010

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