Provider Demographics
NPI:1063934263
Name:B&P DENTAL VENTURES PLLC
Entity type:Organization
Organization Name:B&P DENTAL VENTURES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDNARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-454-5825
Mailing Address - Street 1:711 W 38TH ST STE B10
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1135
Mailing Address - Country:US
Mailing Address - Phone:512-454-5825
Mailing Address - Fax:
Practice Address - Street 1:711 W 38TH ST STE B10
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1135
Practice Address - Country:US
Practice Address - Phone:512-454-5825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX363097201Medicaid
TX32051OtherTEXAS DENTAL LICENSE