Organization
MARK BENAVIDES D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BENAVIDES D.D.S. (OWNER)
(815) 434-0152
Entity
Organization
Contact information
Practice address
1703 POLARIS CIR, OTTAWA, IL 61350-1683
(815) 434-0152
Mailing address
1703 POLARIS CIR, OTTAWA, IL 61350-1683
(815) 434-0152
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0019-20337
IL
Other
Enumeration date
11/14/2006
Last updated
12/17/2013
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