Provider Demographics
NPI:1689944688
Name:CAMP & BENTLEY GENERAL DENTISTRY PA
Entity Type:Organization
Organization Name:CAMP & BENTLEY GENERAL DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-776-1838
Mailing Address - Street 1:2301 E VILLA MARIA RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2550
Mailing Address - Country:US
Mailing Address - Phone:979-776-1838
Mailing Address - Fax:979-774-2808
Practice Address - Street 1:2301 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2550
Practice Address - Country:US
Practice Address - Phone:979-776-1838
Practice Address - Fax:979-774-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133031223G0001X
TX256261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty