Provider Demographics
NPI:1053482489
Name:BENDER, WIILIAM C (DDS,PC)
Entity Type:Individual
Prefix:DR
First Name:WIILIAM
Middle Name:C
Last Name:BENDER
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 2ND ST.
Mailing Address - Street 2:
Mailing Address - City:LASALLE
Mailing Address - State:CO
Mailing Address - Zip Code:80645
Mailing Address - Country:US
Mailing Address - Phone:970-284-7930
Mailing Address - Fax:970-284-6635
Practice Address - Street 1:202 2ND ST.
Practice Address - Street 2:
Practice Address - City:LASALLE
Practice Address - State:CO
Practice Address - Zip Code:80645
Practice Address - Country:US
Practice Address - Phone:970-284-7930
Practice Address - Fax:970-284-6635
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04008587Medicaid