Provider Demographics
NPI:1396850186
Name:BENTLEY, DAN ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:ALLEN
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 KEAGAN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4964
Mailing Address - Country:US
Mailing Address - Phone:806-584-7708
Mailing Address - Fax:
Practice Address - Street 1:2301 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2550
Practice Address - Country:US
Practice Address - Phone:979-776-1838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD133031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice