Healthcare Provider Details

I. General information

NPI: 1396062642
Provider Name (Legal Business Name): PAUL A BENDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 OLD COUNTRY RD SUITE 205
PLAINVIEW NY
11803-6505
US

IV. Provider business mailing address

1097 OLD COUNTRY RD SUITE 205
PLAINVIEW NY
11803-6505
US

V. Phone/Fax

Practice location:
  • Phone: 516-931-8001
  • Fax: 516-931-6527
Mailing address:
  • Phone: 516-931-8001
  • Fax: 516-931-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33151
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: