Provider Demographics
NPI:1316291834
Name:PRITI BENIWAL D.M.D, LLC
Entity type:Organization
Organization Name:PRITI BENIWAL D.M.D, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRITI
Authorized Official - Middle Name:
Authorized Official - Last Name:BENIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-934-0956
Mailing Address - Street 1:20 TREMONT STREET
Mailing Address - Street 2:BLDG 4, SUITE 10A
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332
Mailing Address - Country:US
Mailing Address - Phone:781-934-0956
Mailing Address - Fax:
Practice Address - Street 1:20 TREMONT STREET
Practice Address - Street 2:BLDG 4, SUITE 10A
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332
Practice Address - Country:US
Practice Address - Phone:781-934-0956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN216561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty