Provider Demographics
NPI:1588723423
Name:BENTLEY, MARK THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:BENTLEY
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 1:2170 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9538
Mailing Address - Country:US
Mailing Address - Phone:937-773-3867
Mailing Address - Fax:937-773-6660
Practice Address - Street 1:1523 N MARKET ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-9767
Practice Address - Country:US
Practice Address - Phone:937-335-4630
Practice Address - Fax:937-335-5174
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300145281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice