Provider Demographics
NPI:1518369529
Name:NATHANIEL JON BENT DDS PA
Entity Type:Organization
Organization Name:NATHANIEL JON BENT DDS PA
Other - Org Name:BARKSDALE DENTAL ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:JON
Authorized Official - Last Name:BENT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-756-1513
Mailing Address - Street 1:1907 SHALLCROSS AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2325
Mailing Address - Country:US
Mailing Address - Phone:443-756-1513
Mailing Address - Fax:
Practice Address - Street 1:625 BARKSDALE RD
Practice Address - Street 2:SUITE 115-117
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4535
Practice Address - Country:US
Practice Address - Phone:302-731-4907
Practice Address - Fax:302-731-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-0001205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1336209261Medicaid