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General NPI Number Information
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NPI Number | 1518264225
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Entity Type | Organization
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Legal Business Name | MARK J. BENTELE, DDS, MS, PC
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 2575 MONTEBELLO DR W STE 101
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-6959
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Country | US
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Telephone | 719-268-7138
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Fax | 719-599-5107
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Provider Business Mailing Address
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Address Line | 2575 MONTEBELLO DR W STE 101
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-6959
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Country | US
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Telephone | 719-268-7138
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Fax | 719-599-5107
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK JOSEPH BENTELE
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Credential | DDS, MS
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Telephone | 719-268-7138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9140
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License Number State | CO
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