MEDICARE: DR. STEPHEN T BENDER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	05960	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26043	OTHER	IA	WELLMARK PROVIDER
2	26043	OTHER	IA	DELTA DENTAL USA PROVIDER

General Provider Information

NPI Number	:	1003812017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN T BENDER DDS

Provider Business Mailing Address
First Line	:	1513 MALL DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-3111
Country	:	US
Telephone Number	:	319-354-1409
Fax Number	:	319-354-3113

Provider Business Practice Location Address
First Line	:	1513 MALL DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-3111
Country	:	US
Telephone Number	:	319-354-1409
Fax Number	:	319-354-3113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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