Healthcare Provider Details

I. General information

NPI: 1548322985
Provider Name (Legal Business Name): KARYL YARDENA BENTAL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 RONALD REAGAN DR UNIT 354
EVANS GA
30809-7715
US

IV. Provider business mailing address

607 RONALD REAGAN DR UNIT 354
EVANS GA
30809-7715
US

V. Phone/Fax

Practice location:
  • Phone: 706-225-9201
  • Fax:
Mailing address:
  • Phone: 706-225-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number051198
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21684
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP61482874
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS19766
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: