Provider Demographics
NPI:1558781823
Name:BENTLEY, CHERYL (RDH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 STATE STREET SE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-451-2336
Mailing Address - Fax:616-222-1345
Practice Address - Street 1:255 WASHINGTON ST SE
Practice Address - Street 2:SUITE #4
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4350
Practice Address - Country:US
Practice Address - Phone:616-451-2336
Practice Address - Fax:616-222-1345
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902005257124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist