Provider Demographics
NPI:1134258197
Name:BENDER, VERNON ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:ROBERT
Last Name:BENDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 OLD GRANGER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574
Mailing Address - Country:US
Mailing Address - Phone:512-352-5244
Mailing Address - Fax:512-352-5245
Practice Address - Street 1:1611 OLD GRANGER RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574
Practice Address - Country:US
Practice Address - Phone:512-352-5244
Practice Address - Fax:512-352-5245
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist