Provider Demographics
NPI:1699783753
Name:BENAK, ARNOLD EMERY JR (DMD)
Entity type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:EMERY
Last Name:BENAK
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PEPPERBOX RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-3511
Mailing Address - Country:US
Mailing Address - Phone:860-287-4400
Mailing Address - Fax:860-287-4400
Practice Address - Street 1:317 FLANDERS RD
Practice Address - Street 2:SUITES 204-205
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1711
Practice Address - Country:US
Practice Address - Phone:860-739-5700
Practice Address - Fax:860-739-5279
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66191223G0001X
CT61901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1699783753OtherCT
CT1699783753Medicaid