Provider Demographics
NPI:1568539096
Name:MICHAEL J BENTLEY DDS LTD
Entity Type:Organization
Organization Name:MICHAEL J BENTLEY DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-698-0220
Mailing Address - Street 1:632 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:IL
Mailing Address - Zip Code:61610-3974
Mailing Address - Country:US
Mailing Address - Phone:309-698-0220
Mailing Address - Fax:309-698-0231
Practice Address - Street 1:632 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:IL
Practice Address - Zip Code:61610-3974
Practice Address - Country:US
Practice Address - Phone:309-698-0220
Practice Address - Fax:309-698-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty