Provider Demographics
NPI:1326448309
Name:BENTING, DOUGLAS
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:BENTING
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 1:301 E BETHANY HOME RD STE C194
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1266
Mailing Address - Country:US
Mailing Address - Phone:602-277-9088
Mailing Address - Fax:602-277-8889
Practice Address - Street 1:301 E BETHANY HOME RD STE C194
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1266
Practice Address - Country:US
Practice Address - Phone:602-277-9088
Practice Address - Fax:602-277-8889
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD067551223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics