NPIMap

Organization Active NPI

Mark Benavides D.D.S., P.C.

  • General Practice Dentistry
  • Ottawa, IL
National Provider Identifier
1235201344
Registry record updated Dec 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0019-20337 Issued in IL
Legal business name
MARK BENAVIDES D.D.S., P.C.
Practice address
1703 Polaris Cir
Ottawa, IL 61350-1683
Phone
(815) 434-0152
NPI assigned
Nov 14, 2006
Last updated
Dec 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark Benavides, D.D.S.NPI 1801233606
Title
Owner
Phone
(815) 434-0152

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 0019-20337 IL Primary

Addresses

Primary practice location

1703 Polaris Cir
Ottawa, IL 61350-1683

Mailing address

1703 Polaris Cir
Ottawa, IL 61350-1683
Phone (815) 434-0152

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387238400000",
    "number": "1235201344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 POLARIS CIR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613501683",
            "telephone_number": "815-434-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 POLARIS CIR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613501683",
            "telephone_number": "815-434-0152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK BENAVIDES D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2013-12-17",
        "status": "A",
        "authorized_official_last_name": "BENAVIDES",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-434-0152",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "0019-20337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ottawa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.