Provider Demographics
NPI:1265857486
Name:JEAN L BENINATO DMD, LLC
Entity Type:Organization
Organization Name:JEAN L BENINATO DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENINATO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-374-6655
Mailing Address - Street 1:800 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-1539
Mailing Address - Country:US
Mailing Address - Phone:978-374-6655
Mailing Address - Fax:
Practice Address - Street 1:800 BROADWAY
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-1539
Practice Address - Country:US
Practice Address - Phone:978-374-6655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17618122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty