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NPI Code Detail

MEDICARE: DR. RONALD S BENEDETTI DDS

MEDICARE: DR. RONALD S BENEDETTI DDS
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
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1326156837
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD S BENEDETTI DDS
Provider Business Mailing Address
First Line : 333 DIXIE HWY
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1748
Country : US
Telephone Number : 708-709-6347
Fax Number :
Provider Business Practice Location Address
First Line : 333 DIXIE HWY
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1748
Country : US
Telephone Number : 708-709-6347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 07/08/2007

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