Provider Demographics
NPI:1083807127
Name:DEBRA LOPATOFSKY DMD AND BRUCE BENSE DMD PC
Entity Type:Organization
Organization Name:DEBRA LOPATOFSKY DMD AND BRUCE BENSE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-297-2113
Mailing Address - Street 1:109 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947
Mailing Address - Country:US
Mailing Address - Phone:570-297-2113
Mailing Address - Fax:570-297-3919
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947
Practice Address - Country:US
Practice Address - Phone:570-297-2113
Practice Address - Fax:570-297-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024755L122300000X
PADS024766L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty