Active NPI
Charles J. Bencivengo, D.M.D.
- General Practice Dentistry
- Bristol, CT
National Provider Identifier
1215029368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4945
- Practice address
- 21 Pleasant St
Bristol, CT 06010-6254 - Phone
- (860) 582-8095
- Fax
- (860) 589-3615
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4945 | CT | Primary |
Addresses
Primary practice location
21 Pleasant St
Bristol, CT 06010-6254
Mailing address
21 Pleasant St
Bristol, CT 06010-6254
Phone (860) 582-8095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4945 | CT | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DRS. Bencivengo & Gaudio, D.M.D.,P.C. | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Bristol, CT
- NPI 1659589596
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215029368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 PLEASANT ST",
"city": "BRISTOL",
"state": "CT",
"postal_code": "060106254",
"telephone_number": "860-582-8095",
"fax_number": "860-589-3615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 PLEASANT ST",
"city": "BRISTOL",
"state": "CT",
"postal_code": "060106254",
"telephone_number": "860-582-8095",
"fax_number": "860-589-3615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENCIVENGO",
"first_name": "CHARLES",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CT",
"license": "4945",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bristol, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.