Provider Demographics
NPI:1194394288
Name:BENDER, ERIC MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MICHAEL
Last Name:BENDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17746 KENWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9454
Mailing Address - Country:US
Mailing Address - Phone:952-388-1778
Mailing Address - Fax:952-388-1763
Practice Address - Street 1:17746 KENWOOD TRL
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9454
Practice Address - Country:US
Practice Address - Phone:952-388-1778
Practice Address - Fax:952-388-1763
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN261081223G0001X
MND148471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN26108OtherFLORIDA DENTAL LICENSE
MND14847OtherMINNESOTA DENTAL LICENSE