Provider Demographics
NPI:1730246257
Name:BENEDETTO, DOMINICK A (MD)
Entity type:Individual
Prefix:
First Name:DOMINICK
Middle Name:A
Last Name:BENEDETTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4511
Mailing Address - Country:US
Mailing Address - Phone:772-299-1404
Mailing Address - Fax:772-299-1455
Practice Address - Street 1:3500 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4511
Practice Address - Country:US
Practice Address - Phone:772-299-1404
Practice Address - Fax:772-299-1455
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL134287207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ188606Medicare ID - Type Unspecified
C63032Medicare UPIN