Provider Demographics
NPI:1902973274
Name:BENITEZ, ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 WEST HILLSBOROUGH AVENUE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5757
Mailing Address - Country:US
Mailing Address - Phone:813-872-0665
Mailing Address - Fax:
Practice Address - Street 1:3611 WEST HILLSBOROUGH AVENUE
Practice Address - Street 2:SUITE 214
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5757
Practice Address - Country:US
Practice Address - Phone:813-872-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN7205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist