Provider Demographics
NPI:1851832836
Name:MATTHEW R BENTLEY DMD PC
Entity Type:Organization
Organization Name:MATTHEW R BENTLEY DMD PC
Other - Org Name:BENTLEY DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:817-923-9877
Mailing Address - Street 1:2517 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-2538
Mailing Address - Country:US
Mailing Address - Phone:817-923-9877
Mailing Address - Fax:817-923-9854
Practice Address - Street 1:2517 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-2538
Practice Address - Country:US
Practice Address - Phone:817-923-9877
Practice Address - Fax:817-923-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232801223G0001X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty