Provider Demographics
NPI:1134167323
Name:DIBENEDETTO, DAVID CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:DIBENEDETTO
Suffix:
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 1:54 GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3744
Mailing Address - Country:US
Mailing Address - Phone:781-749-7904
Mailing Address - Fax:
Practice Address - Street 1:243 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1962
Practice Address - Country:US
Practice Address - Phone:781-826-5150
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA146821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice