Provider Demographics
NPI:1659589596
Name:DRS. BENCIVENGO & GAUDIO, D.M.D.,P.C.
Entity Type:Organization
Organization Name:DRS. BENCIVENGO & GAUDIO, D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIQUERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-582-8095
Mailing Address - Street 1:21 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6254
Mailing Address - Country:US
Mailing Address - Phone:860-582-8095
Mailing Address - Fax:860-589-3615
Practice Address - Street 1:21 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6254
Practice Address - Country:US
Practice Address - Phone:860-582-8095
Practice Address - Fax:860-589-3615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4945 AND 69191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty