Provider Demographics
NPI:1437387560
Name:DIBENEDETTO, LAUREN BROOKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:BROOKE
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 MAIN STREET
Mailing Address - Street 2:DWORKIN, STEIN AND LERMAN DENTAL GROUP
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401
Mailing Address - Country:US
Mailing Address - Phone:203-735-4701
Mailing Address - Fax:
Practice Address - Street 1:497 MAIN ST
Practice Address - Street 2:DWORKIN, STEIN AND LERMAN DENTAL GROUP
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-2308
Practice Address - Country:US
Practice Address - Phone:203-735-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0102861223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program