PROVISA

GUDID 00366975025869

Provisa™ Temporary Cement Mixing Tips Pack of 20

BENCO DENTAL SUPPLY CO.

Dental material mixing nozzle, non-sterile

• Primary Device ID: 00366975025869
• NIH Device Record Key: 2bfa8c35-195b-45d8-917b-027ffbbf2a34
• Commercial Distribution Status: In Commercial Distribution
• Brand Name: PROVISA
• Version Model Number: 4080-479
• Company DUNS: 015108087
• Company Name: BENCO DENTAL SUPPLY CO.
• Device Count: 1
• DM Exempt: false
• Pre-market Exempt: true
• MRI Safety Status: Labeling does not contain MRI Safety Information
• Human Cell/Tissue Product: false
• Device Kit: false
• Device Combination Product: false
• Single Use: true
• Lot Batch: false
• Serial Number: false
• Manufacturing Date: false
• Expiration Date: false
• Donation Id Number: false
• Contains Natural Rubber Latex: false
• Labeled No Natural Rubber Latex: false
• RX Perscription: true
• OTC Over-The-Counter: false

Customer Support Contacts

• Phone: 570-602-6924
• Email: jsoroka@benco.com

Device Identifiers

Device Issuing Agency	Device ID
GS1	00366975025869 [Primary]

FDA Product Code

• EID: Syringe, Restorative And Impression Material

Sterilization

• Steralize Prior To Use: false
• Device Is Sterile: false

Device Entry Metadata

• Public Version Status: New
• Device Record Status: Published
• Public Version Number: 1
• Public Version Date: 2018-11-15
• Device Publish Date: 2018-10-15

On-Brand Devices [PROVISA]

• 00366975025951: Provisa™ C&B 10:1 Mix Tip Refill Pack of 25
• 00366975025869: Provisa™ Temporary Cement Mixing Tips Pack of 20
• 00366975001139: Provisa Temp Cement Syr 2x5ml
• 00366975001122: Provisa Temp Cement Syr 1x5ml
• 00366975001108: PROVISA +10 TEMP C&B 50ML BLCH
• 00366975001092: PROVISA +10 TEMP C&B 50ML B1
• 00366975001085: PROVISA +10 TEMP C&B 50ML A3.5
• 00366975001078: PROVISA +10 TEMP C&B 50ML A3
• 00366975001061: PROVISA +10 TEMP C&B 50ML A2
• 00366975001054: PROVISA +10 TEMP C&B 50ML A1
• D74443751880: PROVISA+ C&B TEMP 4:1 BL KT
• D74443751600: PROVISA+ C&B TEMP 4:1 B1 KT
• D74443751510: PROVISA+ C&B TEMP 4:1 A3.5 KT
• D74443751420: PROVISA+ C&B TEMP 4:1 A3 KT
• D74443751330: PROVISA+ C&B TEMP 4:1 A2 KT
• D74443751150: PROVISA+ C&B TEMP 4:1 A1 KT