Healthcare Provider Details

I. General information

NPI: 1003020793
Provider Name (Legal Business Name): JOSEPH P BENINATO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 EAST STREET SUITE 3100
METHUEN MA
01844
US

IV. Provider business mailing address

60 EAST STREET SUITE 3100
METHUEN MA
01844
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-1499
  • Fax: 978-837-6657
Mailing address:
  • Phone: 978-685-1499
  • Fax: 978-837-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16127
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0268569
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: