Healthcare Provider Details

I. General information

NPI: 1366175879
Provider Name (Legal Business Name): BENSON THOMAS E DELOS REYES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 BOSTON AVE
BRIDGEPORT CT
06610-1604
US

IV. Provider business mailing address

2101 QUARRY RD
BRONX NY
10457-1642
US

V. Phone/Fax

Practice location:
  • Phone: 475-265-6522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14926
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: