Provider Demographics
NPI:1902169899
Name:BENAVENT, HARRY HERBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:HERBERT
Last Name:BENAVENT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 N CALVERT ST APT 1101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2255
Mailing Address - Country:US
Mailing Address - Phone:410-746-3715
Mailing Address - Fax:
Practice Address - Street 1:5820 CLARKSVILLE SQUARE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1856
Practice Address - Country:US
Practice Address - Phone:443-535-9600
Practice Address - Fax:443-535-9601
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist