Provider Demographics
NPI:1861510042
Name:RICH, BENEDICT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:
Last Name:RICH
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 1:6 EVERSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5817
Mailing Address - Country:US
Mailing Address - Phone:203-838-2588
Mailing Address - Fax:203-838-1040
Practice Address - Street 1:6 EVERSLEY AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5817
Practice Address - Country:US
Practice Address - Phone:203-838-2588
Practice Address - Fax:203-838-1040
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006665122300000X
NY038826-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice