Active NPI
Nicolas Benavides, DDS
- General Practice Dentistry
- Anderson, SC
National Provider Identifier
1881116002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9134
- Practice address
- 3517 Clemson Blvd
Anderson, SC 29621-1312 - Phone
- (864) 932-4147
- Fax
- (864) 226-2728
- NPI assigned
- Jul 10, 2017
- Last updated
- Aug 15, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30.025188 | OH | |
| General Practice Dentistry | 1223G0001X | 9134 | SC | Primary |
Addresses
Primary practice location
3517 Clemson Blvd
Anderson, SC 29621-1312
Mailing address
2700 Sunset Blvd
Steubenville, OH 43952-1158
Phone (740) 264-6811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9134 | SC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Complete Dental Care of Newcmerstown | General Practice | Past | Accepting new patients |
| Professional Dental Alliance of Newcomerstown, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Newcomerstown, OH
- NPI 1154841609
-
- Dentist
- Newcomerstown, OH
- NPI 1518428978
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660521600000",
"number": "1881116002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2700 SUNSET BLVD",
"city": "STEUBENVILLE",
"state": "OH",
"postal_code": "439521158",
"telephone_number": "740-264-6811",
"fax_number": "740-264-6812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3517 CLEMSON BLVD",
"city": "ANDERSON",
"state": "SC",
"postal_code": "296211312",
"telephone_number": "864-932-4147",
"fax_number": "864-226-2728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENAVIDES",
"first_name": "NICOLAS",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-07-10",
"last_updated": "2022-08-15",
"certification_date": "2022-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "30.025188",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "9134",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anderson, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.