MEDICARE: THERESA HANH DANG BENTLEY

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	D32054	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154392769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA HANH DANG BENTLEY

Provider Business Mailing Address
First Line	:	4015 N FRESNO ST
Second Line	:	SUITE 110
City	:	FRESNO
State	:	CA
Zip	:	93726-4023
Country	:	US
Telephone Number	:	559-224-4860
Fax Number	:	559-224-0802

Provider Business Practice Location Address
First Line	:	4015 N FRESNO ST
Second Line	:	SUITE 110
City	:	FRESNO
State	:	CA
Zip	:	93726-4023
Country	:	US
Telephone Number	:	559-224-4860
Fax Number	:	559-224-0802

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	07/09/2007

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