Provider Demographics
NPI:1174724801
Name:RICHARD P BENOIT DMD PC
Entity type:Organization
Organization Name:RICHARD P BENOIT DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:BENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-388-2107
Mailing Address - Street 1:123 ELM STREET
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475
Mailing Address - Country:US
Mailing Address - Phone:860-388-2107
Mailing Address - Fax:860-510-0546
Practice Address - Street 1:123 ELM STREET
Practice Address - Street 2:SUITE 1300
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475
Practice Address - Country:US
Practice Address - Phone:860-388-2107
Practice Address - Fax:860-510-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty