Provider Demographics
NPI:1851428346
Name:BENTLEY, SONJA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:SONJA
Middle Name:A
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 5TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-2415
Mailing Address - Country:US
Mailing Address - Phone:615-384-8441
Mailing Address - Fax:615-382-2958
Practice Address - Street 1:205 5TH AVE W
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2415
Practice Address - Country:US
Practice Address - Phone:615-384-8441
Practice Address - Fax:615-382-2958
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000045941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice