Provider Demographics
NPI:1568579431
Name:BENTZ, JANE ANN (DDS)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:BENTZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ANN
Other - Last Name:MATELSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1845 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8668
Mailing Address - Country:US
Mailing Address - Phone:608-783-8333
Mailing Address - Fax:608-783-5942
Practice Address - Street 1:1845 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8668
Practice Address - Country:US
Practice Address - Phone:608-783-8333
Practice Address - Fax:608-783-5942
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI192311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics