Individual
MARY C DIBENEDETTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3075 GOVERNORS PLACE BLVD STE 120, KETTERING, OH 45409-1332
(937) 424-2580
(937) 424-3581
Mailing address
3075 GOVERNORS PLACE BLVD, SUITE 210, DAYTON, OH 45409-1332
(937) 424-8258
(937) 424-2581
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
003057
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538113295
NPI
—
Enumeration date
05/19/2006
Last updated
11/19/2018
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