Provider Demographics
NPI:1912934654
Name:BENDER, BRENT ALAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALAN
Last Name:BENDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N ZANG BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4337
Mailing Address - Country:US
Mailing Address - Phone:214-946-3668
Mailing Address - Fax:214-943-5130
Practice Address - Street 1:630 N BISHOP AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4335
Practice Address - Country:US
Practice Address - Phone:214-946-3668
Practice Address - Fax:214-943-5130
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1423213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0927469 -02Medicaid
TX00815EMedicare ID - Type Unspecified
TXU72442Medicare UPIN
TX4915670001Medicare NSC