Provider Demographics
NPI:1215147939
Name:BENDER WINEGAR LLC
Entity type:Organization
Organization Name:BENDER WINEGAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-829-0795
Mailing Address - Street 1:1903 S 6TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-4599
Mailing Address - Country:US
Mailing Address - Phone:218-829-0795
Mailing Address - Fax:218-829-6871
Practice Address - Street 1:1903 S 6TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-4599
Practice Address - Country:US
Practice Address - Phone:218-829-0795
Practice Address - Fax:218-829-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty