Provider Demographics
NPI:1003020793
Name:BENINATO, JOSEPH P (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:BENINATO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 EAST STREET
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844
Mailing Address - Country:US
Mailing Address - Phone:978-685-1499
Mailing Address - Fax:978-837-6657
Practice Address - Street 1:60 EAST STREET
Practice Address - Street 2:SUITE 3100
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844
Practice Address - Country:US
Practice Address - Phone:978-685-1499
Practice Address - Fax:978-837-6657
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0268569Medicaid