Provider Demographics
NPI:1093258675
Name:MAURO V. DIBENEDETTO DMD PC
Entity Type:Organization
Organization Name:MAURO V. DIBENEDETTO DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURO
Authorized Official - Middle Name:V
Authorized Official - Last Name:DIBENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-288-3223
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11977-0143
Mailing Address - Country:US
Mailing Address - Phone:631-288-3223
Mailing Address - Fax:
Practice Address - Street 1:380 MILL RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2063
Practice Address - Country:US
Practice Address - Phone:631-288-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty