Provider Demographics
NPI:1073502274
Name:BENDALE, SURESH N (DDS)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:N
Last Name:BENDALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CLIFF ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3411
Mailing Address - Country:US
Mailing Address - Phone:201-659-5980
Mailing Address - Fax:201-659-5980
Practice Address - Street 1:337 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2738
Practice Address - Country:US
Practice Address - Phone:718-366-4107
Practice Address - Fax:718-366-4107
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039877-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00952561Medicaid