Provider Demographics
NPI:1790481612
Name:RESOLUTE BENAK
Entity Type:Organization
Organization Name:RESOLUTE BENAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MASTROTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-739-5700
Mailing Address - Street 1:317 FLANDERS ROAD
Mailing Address - Street 2:UNIT 205
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333
Mailing Address - Country:US
Mailing Address - Phone:860-739-5700
Mailing Address - Fax:
Practice Address - Street 1:317 FLANDERS ROAD
Practice Address - Street 2:UNIT 205
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333
Practice Address - Country:US
Practice Address - Phone:860-739-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty