Provider Demographics
NPI:1336209261
Name:BENT, NATHANIEL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:J
Last Name:BENT
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 1:1907 SHALLCROSS AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2325
Mailing Address - Country:US
Mailing Address - Phone:443-756-1513
Mailing Address - Fax:
Practice Address - Street 1:1907 SHALLCROSS AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-2325
Practice Address - Country:US
Practice Address - Phone:443-756-1513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10001205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist