Provider Demographics
NPI:1063584258
Name:BENDER, ROBERT J (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BENDER
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 1:1903 SOUTH 6TH STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401
Mailing Address - Country:US
Mailing Address - Phone:218-829-0795
Mailing Address - Fax:218-829-6871
Practice Address - Street 1:1903 SOUTH 6TH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401
Practice Address - Country:US
Practice Address - Phone:218-829-0795
Practice Address - Fax:218-829-6871
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8178122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist