Provider Demographics
NPI:1295973741
Name:BANTLEY, DAVID T (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:BANTLEY
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 1:858 E WELSH RD
Mailing Address - Street 2:SUITE#1
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2942
Mailing Address - Country:US
Mailing Address - Phone:215-646-4411
Mailing Address - Fax:215-643-1774
Practice Address - Street 1:858 E WELSH RD
Practice Address - Street 2:SUITE #1
Practice Address - City:MAPLE GLEN
Practice Address - State:PA
Practice Address - Zip Code:19002-2942
Practice Address - Country:US
Practice Address - Phone:215-646-4411
Practice Address - Fax:215-643-1774
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027153L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist