Provider Demographics
NPI:1659608180
Name:BENTKOVER FACIAL PLASTIC SURGERY & LASER CENTER
Entity Type:Organization
Organization Name:BENTKOVER FACIAL PLASTIC SURGERY & LASER CENTER
Other - Org Name:DR. STUART H. BENTKOVER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:H
Authorized Official - Last Name:BENTKOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, FACS
Authorized Official - Phone:508-363-6500
Mailing Address - Street 1:5 LANTERN LANE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609
Mailing Address - Country:US
Mailing Address - Phone:508-363-6500
Mailing Address - Fax:508-363-6501
Practice Address - Street 1:92 MONTVALE AVE.
Practice Address - Street 2:SUITE 3000
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:508-363-6500
Practice Address - Fax:508-363-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38152207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA36101Medicare UPIN