Provider Demographics
NPI:1124387444
Name:BENOIT, RICHARD P (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:BENOIT
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 1:123 ELM ST
Mailing Address - Street 2:SUITE # 900
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4108
Mailing Address - Country:US
Mailing Address - Phone:860-388-0242
Mailing Address - Fax:860-388-6495
Practice Address - Street 1:123 ELM ST
Practice Address - Street 2:SUITE # 900
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4108
Practice Address - Country:US
Practice Address - Phone:860-388-0242
Practice Address - Fax:860-388-6495
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079931223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health