Provider Demographics
NPI:1811125578
Name:DIBENEDETTO, STEPHEN CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHARLES
Last Name:DIBENEDETTO
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 1:30 QUAKER FARMS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2732
Mailing Address - Country:US
Mailing Address - Phone:203-264-4351
Mailing Address - Fax:203-264-8751
Practice Address - Street 1:30 QUAKER FARMS RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2732
Practice Address - Country:US
Practice Address - Phone:203-264-4351
Practice Address - Fax:203-264-8751
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0100631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice