Healthcare Provider Details

I. General information

NPI: 1649344268
Provider Name (Legal Business Name): COOLEY BENTZ DENTAL ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 DEKALB PIKE
E NORRITON PA
19401
US

IV. Provider business mailing address

2601 DEKALB PIKE
E NORRITON PA
19401
US

V. Phone/Fax

Practice location:
  • Phone: 610-272-6949
  • Fax: 610-272-8664
Mailing address:
  • Phone: 610-272-6949
  • Fax: 610-272-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS027633L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS028931L
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierU56301
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: ROBERT M BENTZ
Title or Position: OWNER
Credential: DMD
Phone: 610-272-6949