Provider Demographics
NPI:1003940420
Name:BENOIT, DIANE E (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:E
Last Name:BENOIT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4021
Mailing Address - Country:US
Mailing Address - Phone:603-228-1771
Mailing Address - Fax:603-228-2042
Practice Address - Street 1:29 GREEN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4021
Practice Address - Country:US
Practice Address - Phone:603-228-1771
Practice Address - Fax:603-228-2042
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH24721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice