Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 007993 | CT |
Y | 1223G0001X | General Practice | 007993 | CT |
Y | 213EG0000X | General Practice | 007993 | CT |
NPI | 1124387444 |
---|---|
Provider Name | Dr. Richard P. Benoit |
First Address | Old Saybrook, CT 06475-4108 |
Second Address | Old Saybrook, CT 06475-4108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2012 |
Last Update Date | 07/05/2012 |