Healthcare Provider Details

I. General information

NPI: 1780378810
Provider Name (Legal Business Name): DR. BENJAMIN GROSSMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SOUTH ST W
RAYNHAM MA
02767-5342
US

IV. Provider business mailing address

133 CLARENDON ST PO BOX 171012
BOSTON MA
02117
US

V. Phone/Fax

Practice location:
  • Phone: 508-822-6565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1859878
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: