Provider Demographics
NPI:1720187792
Name:BENSIANOFF, ANATOLY (DDS)
Entity Type:Individual
Prefix:
First Name:ANATOLY
Middle Name:
Last Name:BENSIANOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N WOOD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4173
Mailing Address - Country:US
Mailing Address - Phone:908-486-5000
Mailing Address - Fax:908-486-5006
Practice Address - Street 1:515 N WOOD AVE STE 102
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4173
Practice Address - Country:US
Practice Address - Phone:908-486-5000
Practice Address - Fax:908-486-5006
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ21791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist