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General NPI Number Information
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NPI Number | 1194394288
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Entity Type | Individual
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Provider Name | ERIC MICHAEL BENDER DMD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 17746 KENWOOD TRL
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City | LAKEVILLE
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State | MN
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Zip | 55044-9454
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Country | US
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Telephone | 952-388-1778
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Fax | 952-388-1763
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Provider Business Mailing Address
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Address Line | 17746 KENWOOD TRL
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City | LAKEVILLE
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State | MN
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Zip | 55044-9454
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Country | US
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Telephone | 952-388-1778
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Fax | 952-388-1763
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN26108
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D14847
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License Number State | MN
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