Individual
DR. NATHANAEL DAVID BENASSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
8391 GREENWAY BLVD STE 100, MIDDLETON, WI 53562-3544
(815) 979-3837
Mailing address
8391 GREENWAY BLVD STE 100, MIDDLETON, WI 53562-3544
(608) 535-9382
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.029572
IL
1223P0221X
Pediatric Dentistry
Primary
1002348
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019-029572
IL STATE DENTAL LICENSE
IL
Enumeration date
08/13/2013
Last updated
04/28/2022
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