Provider Demographics
NPI:1205972197
Name:BECHTLOFF, RUSSEL T (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSSEL
Middle Name:T
Last Name:BECHTLOFF
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:400 N BUCKSTOWN RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8310
Mailing Address - Country:US
Mailing Address - Phone:215-750-1717
Mailing Address - Fax:215-750-6109
Practice Address - Street 1:400 N BUCKSTOWN RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8310
Practice Address - Country:US
Practice Address - Phone:215-750-1717
Practice Address - Fax:215-750-6109
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADSO17051L1223P0300X
PADSO17971L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0300XDental ProvidersDentistPeriodontics
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry