Provider Demographics
NPI:1255402590
Name:BENDER DENTAL GROUP
Entity type:Organization
Organization Name:BENDER DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-285-3030
Mailing Address - Street 1:313 PRIMOSE LANE
Mailing Address - Street 2:SUITE A B
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554
Mailing Address - Country:US
Mailing Address - Phone:717-285-3030
Mailing Address - Fax:717-285-2906
Practice Address - Street 1:313 PRIMOSE LANE
Practice Address - Street 2:SUITE A B
Practice Address - City:MOUNTVILLE
Practice Address - State:PA
Practice Address - Zip Code:17554
Practice Address - Country:US
Practice Address - Phone:717-285-3030
Practice Address - Fax:717-285-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024308L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty