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General NPI Number Information
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NPI Number | 1689944688
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Entity Type | Organization
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Legal Business Name | CAMP & BENTLEY GENERAL DENTISTRY PA
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 2301 E VILLA MARIA RD
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City | BRYAN
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State | TX
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Zip | 77802-2550
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Country | US
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Telephone | 979-776-1838
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Fax | 979-774-2808
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Provider Business Mailing Address
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Address Line | 2301 E VILLA MARIA RD
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City | BRYAN
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State | TX
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Zip | 77802-2550
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Country | US
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Telephone | 979-776-1838
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Fax | 979-774-2808
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAN A. BENTLEY
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Credential | D.D.S.
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Telephone | 979-776-1838
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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 | 25626
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License Number State | TX
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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 | 13303
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License Number State | TX
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