Paul R Dibenedetto, D.D.S.
Individual provider Active NPI General Practice Dentistry · Lancaster, NY
NPI 1649345877 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1649345877
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 034246-1 (NY)
- Practice address
- 5755 Broadway St
Lancaster, NY 14086-2357 - Phone
- (716) 683-0891
- NPI assigned
- Nov 22, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160321001812 | NY | Order and Referring Only - Dentist |
4688971526 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034246-1 | NY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lancaster Dental Associates, PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 034246-1 | NY | Yes |
Addresses
Primary practice location
5755 Broadway St
Lancaster, NY 14086-2357
Mailing address
272 Greengage Cir
East Amherst, NY 14051-2128
Phone (716) 689-4841
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00638055 | Medicaid | NY |
Other providers in Lancaster, NY
- Christopher Dabski
- Sharon Deacon
- Kimberly Deangelis
- Keri Demyanick
- Kristin Marie Diangelo
- Talia Dichristina
- Dr. Donna Orlando-Martin
- Christine L. Drews
- Katie M Drummond
- E2 Medical Supplies
All providers in Lancaster, NY · General Practice Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.