Provider Demographics
NPI:1043468721
Name:BENEDEK, SHANNON R (RDH)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:BENEDEK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1013
Mailing Address - Country:US
Mailing Address - Phone:716-425-6451
Mailing Address - Fax:716-297-0998
Practice Address - Street 1:430 MORGAN DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1013
Practice Address - Country:US
Practice Address - Phone:716-425-6451
Practice Address - Fax:716-297-0998
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025017124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025017OtherNYS LICENSE