Provider Demographics
NPI:1629390042
Name:BENDER DENTAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:BENDER DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BAXTER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-846-0422
Mailing Address - Street 1:45 LENOX POINTE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3162
Mailing Address - Country:US
Mailing Address - Phone:404-846-0422
Mailing Address - Fax:404-846-0425
Practice Address - Street 1:45 LENOX POINTE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3162
Practice Address - Country:US
Practice Address - Phone:404-846-0422
Practice Address - Fax:404-846-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN00103871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty