Provider Demographics
NPI:1578019329
Name:B&P DENTAL ENTITIES LLC
Entity Type:Organization
Organization Name:B&P DENTAL ENTITIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDNARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-444-4867
Mailing Address - Street 1:1901 W WILLIAM CANNON DR STE 143
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 W WILLIAM CANNON DR STE 143
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5327
Practice Address - Country:US
Practice Address - Phone:512-444-4867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32051261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32051OtherTEXAS DENTAL BOARD