MEDICARE: MR. MICHAEL GEORGE BENAC 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
1	122300000X	Dentist	12008994	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	575315	OTHER		UN CONCORDIA

General Provider Information

NPI Number	:	1467524843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL GEORGE BENAC DDS

Provider Business Mailing Address
First Line	:	1518 WASHINGTON STREET
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-4355
Country	:	US
Telephone Number	:	765-521-0336
Fax Number	:	765-521-0337

Provider Business Practice Location Address
First Line	:	1518 WASHINGTON STREET
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-4355
Country	:	US
Telephone Number	:	765-521-0336
Fax Number	:	765-521-0337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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