Provider Demographics
NPI:1285194738
Name:BENDER DENTAL LLC
Entity Type:Organization
Organization Name:BENDER DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-230-1220
Mailing Address - Street 1:1713 N 3780 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4198
Mailing Address - Country:US
Mailing Address - Phone:801-230-1220
Mailing Address - Fax:
Practice Address - Street 1:1345 E FORT UNION BLVD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2859
Practice Address - Country:US
Practice Address - Phone:801-943-3408
Practice Address - Fax:866-611-4680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental