Active NPI
Gary Lynn Bennicoff, D.D.S.
- General Practice Dentistry
- Easton, PA
National Provider Identifier
1487782454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS024212-L
- Practice address
- 1305 Tatamy Rd
Easton, PA 18045-7474 - Phone
- (610) 252-2223
- Fax
- (610) 252-4099
- NPI assigned
- Mar 1, 2007
- Last updated
- Sep 2, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 | DS024212-L | PA | Primary |
Addresses
Primary practice location
1305 Tatamy Rd
Easton, PA 18045-7474
Mailing address
1305 Tatamy Rd
Easton, PA 18045-7474
Phone (610) 252-2223
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 8, 2020 through Dec 8, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS024212-L | PA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220313600000",
"number": "1487782454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1305 TATAMY RD",
"city": "EASTON",
"state": "PA",
"postal_code": "180457474",
"telephone_number": "610-252-2223",
"fax_number": "610-252-4099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 TATAMY RD",
"city": "EASTON",
"state": "PA",
"postal_code": "180457474",
"telephone_number": "610-252-2223",
"fax_number": "610-252-4099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNICOFF",
"first_name": "GARY",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-01",
"last_updated": "2008-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS024212-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Easton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.