Audrey Nicole Imperial

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D010674 Issued in AZ

Practice address

59 DG Af Postgraduate Dental School
2133 Pepperrell St BLDG 3352
Jbsa - Lackland, TX 78236-5313

Phone

(210) 292-6258

NPI assigned

Mar 2, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Audrey Nicole Benavides Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1583107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1972137644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 TRUEMPER ST",
            "city": "LACKLAND AFB",
            "state": "TX",
            "postal_code": "782365511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 DG AF POSTGRADUATE DENTAL SCHOOL",
            "address_2": "2133 PEPPERRELL ST BLDG 3352",
            "city": "JBSA - LACKLAND",
            "state": "TX",
            "postal_code": "782365313",
            "telephone_number": "210-292-6258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMPERIAL",
        "first_name": "AUDREY",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-02",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D010674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDREY",
            "last_name": "BENAVIDES",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dana Austin Hunter Jr., PA
• Michael A Huott, M.D.
• Cesar Iglesias, PA-C
• Janet Ilidan
• Jennifer Yvonne Imani, DDS
• Sonia Iqbal, DO
• Scott Irwin, D.D.S., MPH
• Norris Jackson, MD
• Bonnie Lynn Jago, CRNA
• Shreya Jain

• General Practice Dentistry in Jbsa - Lackland, TX
• Providers in Jbsa - Lackland, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; 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.