Provider Demographics
NPI:1417300385
Name:BENT, BEAU-CABEL ALEXANDRE
Entity Type:Individual
Prefix:
First Name:BEAU-CABEL
Middle Name:ALEXANDRE
Last Name:BENT
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 1:894Q DEUBEL RD
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-9734
Mailing Address - Country:US
Mailing Address - Phone:509-230-5554
Mailing Address - Fax:
Practice Address - Street 1:370 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2310
Practice Address - Country:US
Practice Address - Phone:509-684-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60661092122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist