Provider Demographics
NPI:1598159980
Name:BENTON DENTAL P.C
Entity Type:Organization
Organization Name:BENTON DENTAL P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:GUZE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-721-0707
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:EAST WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04234-0390
Mailing Address - Country:US
Mailing Address - Phone:207-645-9522
Mailing Address - Fax:207-645-9516
Practice Address - Street 1:1445 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST WILTON
Practice Address - State:ME
Practice Address - Zip Code:04234
Practice Address - Country:US
Practice Address - Phone:207-645-9522
Practice Address - Fax:207-645-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4351261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental