Provider Demographics
NPI:1285162073
Name:BENDER, ANGIE LYN (RDH)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:LYN
Last Name:BENDER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:LYN
Other - Last Name:STOMBERSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:5095 RIFLE RIVER TRAIL
Mailing Address - Street 2:
Mailing Address - City:ALGER
Mailing Address - State:MI
Mailing Address - Zip Code:48610-9327
Mailing Address - Country:US
Mailing Address - Phone:989-873-5152
Mailing Address - Fax:989-873-5913
Practice Address - Street 1:5095 RIFLE RIVER TRAIL
Practice Address - Street 2:
Practice Address - City:ALGER
Practice Address - State:MI
Practice Address - Zip Code:48610-9327
Practice Address - Country:US
Practice Address - Phone:989-873-5152
Practice Address - Fax:989-873-5913
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902018130124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist