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General NPI Number Information
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NPI Number | 1093258675
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Entity Type | Organization
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Legal Business Name | MAURO V. DIBENEDETTO DMD PC
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 380 MILL RD
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City | WESTHAMPTON BEACH
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State | NY
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Zip | 11978-2063
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Country | US
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Telephone | 631-288-3223
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 143
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City | WESTHAMPTON
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State | NY
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Zip | 11977-0143
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Country | US
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Telephone | 631-288-3223
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MAURO V DIBENEDETTO
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Credential | DMD
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Telephone | 631-288-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 043792
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License Number State | NY
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