Provider Demographics
NPI:1093840241
Name:BENIWAL, PRITI (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRITI
Middle Name:
Last Name:BENIWAL
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 1:9 KIMBALL COURT
Mailing Address - Street 2:APT #1005
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803
Mailing Address - Country:US
Mailing Address - Phone:617-899-2233
Mailing Address - Fax:
Practice Address - Street 1:459 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3614
Practice Address - Country:US
Practice Address - Phone:617-389-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice