MEDICARE: JASON ANTHONY BENDAS 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	103816	CA
2	122300000X	Dentist	103816	CA

General Provider Information

NPI Number	:	1962054700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON ANTHONY BENDAS DDS

Provider Business Mailing Address
First Line	:	1833 FELSITE ST
Second Line	:
City	:	LOS BANOS
State	:	CA
Zip	:	93635-8835
Country	:	US
Telephone Number	:	951-240-8082
Fax Number	:

Provider Business Practice Location Address
First Line	:	816 2ND ST
Second Line	:
City	:	LOS BANOS
State	:	CA
Zip	:	93635-4124
Country	:	US
Telephone Number	:	209-826-8100
Fax Number	:

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

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	10/06/2020

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