Healthcare Provider Details

I. General information

NPI: 1679515845
Provider Name (Legal Business Name): MARK JOESPH BENTELE DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 MONTEBELLO DR W STE 101
COLORADO SPRINGS CO
80918-6959
US

IV. Provider business mailing address

2575 MONTEBELLO DR W STE 101
COLORADO SPRINGS CO
80918-6959
US

V. Phone/Fax

Practice location:
  • Phone: 719-268-7138
  • Fax: 719-599-5107
Mailing address:
  • Phone: 719-268-7138
  • Fax: 719-599-5107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9140
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: