Provider Demographics
NPI:1205315462
Name:MAIN STREET DENTAL OF LITTLETON PLLC
Entity type:Organization
Organization Name:MAIN STREET DENTAL OF LITTLETON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENENATI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-938-2690
Mailing Address - Street 1:31 OLD SUTTON RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03221-3507
Mailing Address - Country:US
Mailing Address - Phone:603-938-2690
Mailing Address - Fax:
Practice Address - Street 1:186 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4014
Practice Address - Country:US
Practice Address - Phone:603-444-6811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH34701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty