Provider Demographics
NPI:1518264225
Name:MARK J. BENTELE, DDS, MS, PC
Entity Type:Organization
Organization Name:MARK J. BENTELE, DDS, MS, PC
Other - Org Name:BENTELE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BENTELE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:719-268-7138
Mailing Address - Street 1:2575 MONTEBELLO DR W STE 101
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6959
Mailing Address - Country:US
Mailing Address - Phone:719-268-7138
Mailing Address - Fax:719-599-5107
Practice Address - Street 1:2575 MONTEBELLO DR W STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6959
Practice Address - Country:US
Practice Address - Phone:719-268-7138
Practice Address - Fax:719-599-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty