PROVISA

GUDID D74443751150

PROVISA+ C&B TEMP 4:1 A1 KT

BENCO DENTAL SUPPLY CO.

Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge Temporary dental crown/bridge

• Primary Device ID: D74443751150
• NIH Device Record Key: c8cf60ff-c616-439a-a0f2-772c2e0f137d
• Commercial Distribution Status: In Commercial Distribution
• Brand Name: PROVISA
• Version Model Number: 4375-115
• Company DUNS: 015108087
• Company Name: BENCO DENTAL SUPPLY CO.
• Device Count: 1
• DM Exempt: false
• Pre-market Exempt: false
• MRI Safety Status: Labeling does not contain MRI Safety Information
• Human Cell/Tissue Product: false
• Device Kit: false
• Device Combination Product: false
• Single Use: false
• Lot Batch: true
• Serial Number: false
• Manufacturing Date: false
• Expiration Date: true
• Donation Id Number: false
• Contains Natural Rubber Latex: false
• Labeled No Natural Rubber Latex: false
• RX Perscription: true
• OTC Over-The-Counter: false

Operating and Storage Conditions

• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit
• Storage Environment Temperature: Between 39 Degrees Fahrenheit and 73 Degrees Fahrenheit

Device Identifiers

Device Issuing Agency	Device ID
HIBCC	D74443751150 [Primary]

FDA Product Code

• EBG: Crown And Bridge, Temporary, Resin

Sterilization

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

Device Entry Metadata

• Public Version Status: Update
• Device Record Status: Published
• Public Version Number: 3
• Public Version Date: 2021-10-29
• Device Publish Date: 2016-09-23

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