Healthcare Provider Details

I. General information

NPI: 1699515171
Provider Name (Legal Business Name): BENNETT SHERWOOD DELONG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142A CANAL ST
SALEM MA
01970-4650
US

IV. Provider business mailing address

142A CANAL ST
SALEM MA
01970-4650
US

V. Phone/Fax

Practice location:
  • Phone: 781-598-3700
  • Fax:
Mailing address:
  • Phone: 781-598-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001407
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: