Provider Demographics
NPI:1154218741
Name:BENDER, DAWAN JUDE
Entity type:Individual
Prefix:
First Name:DAWAN
Middle Name:JUDE
Last Name:BENDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 OTONO RD APT E3
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6368
Mailing Address - Country:US
Mailing Address - Phone:575-741-6727
Mailing Address - Fax:
Practice Address - Street 1:110 OTONO RD APT E3
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6368
Practice Address - Country:US
Practice Address - Phone:575-741-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1829225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist