Provider Demographics
NPI:1346722097
Name:BENTZ, HALLE
Entity Type:Individual
Prefix:
First Name:HALLE
Middle Name:
Last Name:BENTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15055 ALMONT RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48002-3011
Mailing Address - Country:US
Mailing Address - Phone:810-751-3881
Mailing Address - Fax:
Practice Address - Street 1:38865 DEQUINDRE RD STE 105
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-879-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902018529124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist