Provider Demographics
NPI:1568272045
Name:BENCOSME, ANA KAREN (DDS)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:KAREN
Last Name:BENCOSME
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 WALNUT ST STE 1802
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3612
Mailing Address - Country:US
Mailing Address - Phone:267-810-8151
Mailing Address - Fax:
Practice Address - Street 1:1000 EASTON RD STE 315
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-2900
Practice Address - Country:US
Practice Address - Phone:267-631-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42024122300000X
NJ22DI03122100122300000X
PADS045428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist