MEDICARE: DR. JOSEPH ANTHONY BENEDETTO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3683	ME

General Provider Information

NPI Number	:	1487685335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ANTHONY BENEDETTO D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 725
Second Line	:
City	:	CALAIS
State	:	ME
Zip	:	04619-0725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 ELM PLAZA
Second Line	:
City	:	WATERVILLE
State	:	ME
Zip	:	04901-0000
Country	:	US
Telephone Number	:	207-873-0110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	11/19/2007

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