Provider Demographics
NPI:1215034962
Name:BENDER, FARA (DMD)
Entity Type:Individual
Prefix:DR
First Name:FARA
Middle Name:
Last Name:BENDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6169 JOG RD
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6579
Mailing Address - Country:US
Mailing Address - Phone:561-433-5544
Mailing Address - Fax:561-433-4440
Practice Address - Street 1:6169 JOG RD
Practice Address - Street 2:SUITE B-5
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6579
Practice Address - Country:US
Practice Address - Phone:561-433-5544
Practice Address - Fax:561-433-4440
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN150721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry