Provider Demographics
NPI:1528197332
Name:ROBERT A BENNY DDS PC
Entity Type:Organization
Organization Name:ROBERT A BENNY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENNY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-235-6153
Mailing Address - Street 1:40 GROVE ST
Mailing Address - Street 2:SUITE 425
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7702
Mailing Address - Country:US
Mailing Address - Phone:781-235-6153
Mailing Address - Fax:781-239-1694
Practice Address - Street 1:40 GROVE ST
Practice Address - Street 2:SUITE 425
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7702
Practice Address - Country:US
Practice Address - Phone:781-235-6153
Practice Address - Fax:781-239-1694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX03693Medicare ID - Type Unspecified
MAU77667Medicare UPIN