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General NPI Number Information
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NPI Number | 1568591360
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Entity Type | Individual
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Provider Name | ROBERT A BENNY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 40 GROVE ST SUITE 425
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City | WELLESLEY
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State | MA
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Zip | 02482-7702
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Country | US
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Telephone | 781-235-6153
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Fax | 781-239-1694
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Provider Business Mailing Address
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Address Line | 40 GROVE ST SUITE 425
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City | WELLESLEY
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State | MA
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Zip | 02482-7702
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Country | US
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Telephone | 781-235-6153
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Fax | 781-239-1694
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 10624
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License Number State | MA
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