Individual
DR. MARK BENAVIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1703 POLARIS CIR, SUITE 3, OTTAWA, IL 61350-1683
(815) 434-0152
(815) 434-0156
Mailing address
1703 POLARIS CIR, SUITE 3, OTTAWA, IL 61350-1683
(815) 434-0152
(815) 434-0156
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19020337
IL
Other
Enumeration date
06/03/2013
Last updated
12/17/2013
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