DR. GARY LYNN BENNICOFF, D.D.S. - NPI NUMBER 1487782454

Summary

Provider Name: DR. GARY LYNN BENNICOFF, D.D.S.

NPI Number: 1487782454

Clasification: Dentist (1223G0001X)

Specialization: General Practice

Address:
1305 TATAMY RD
EASTON, PA
ZIP 18045

Phone Number: (610) 252-2223



Detailed Information

DR. Gary Lynn Bennicoff, D.D.S. is a general practice dentist in Easton, PA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. The assigned NPI number for this provider is 1487782454 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business address is:

1305 TATAMY RD
EASTON, PA
ZIP 18045-474
Phone: (610) 252-2223
Fax: (610) 252-4099

The enumeration date for this NPI number is 3/1/2007 and was last updated on 9/2/2008.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 1223G0001X Dentist General Practice DS024212-L PA Yes

NPI Record

No. Field Name Field Value
1 NPI 1487782454
2 Entity Type Code 1
3 Provider Last Name Legal Name BENNICOFF
4 Provider First Name GARY
5 Provider Middle Name LYNN
6 Provider Name Prefix Text DR.
7 Provider Credential Text D.D.S.
8 Provider First Line Business Practice Location Address 1305 TATAMY RD
9 Provider Business Practice Location Address City Name EASTON
10 Provider Business Practice Location Address State Name PA
11 Provider Business Practice Location Address Postal Code 180457474
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 6102522223
14 Provider Business Practice Location Address Fax Number 6102524099
15 Provider Enumeration Date 3/1/2007
16 Last Update Date 9/2/2008
17 Provider Gender Code M
18 Healthcare Provider Taxonomy Code 1 1223G0001X
19 Provider License Number 1 DS024212-L
20 Provider License Number State Code 1 PA
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Sole Proprietor Y

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This page was last updated on: 8/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.