Provider Demographics
NPI:1083764146
Name:KURT A BENDER DDS PA
Entity Type:Organization
Organization Name:KURT A BENDER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-427-7700
Mailing Address - Street 1:500 A JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316
Mailing Address - Country:US
Mailing Address - Phone:763-427-7700
Mailing Address - Fax:763-323-8075
Practice Address - Street 1:500 A JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316
Practice Address - Country:US
Practice Address - Phone:763-427-7700
Practice Address - Fax:763-323-8075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty