Provider Demographics
NPI:1558979195
Name:GALPERIN, BENNETT IAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:IAN
Last Name:GALPERIN
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 1:11R S MAIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2424
Mailing Address - Country:US
Mailing Address - Phone:732-599-1409
Mailing Address - Fax:
Practice Address - Street 1:376 COOLEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01128-1144
Practice Address - Country:US
Practice Address - Phone:413-796-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23910122300000X, 1223X0400X
CT128971223X0400X
MADN18587921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist