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General NPI Number Information
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NPI Number | 1740339902
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Entity Type | Individual
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Provider Name | BRUCE EDISON BENTLEY JR. D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 1229 LEANDER RD
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City | GEORGETOWN
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State | TX
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Zip | 78628-8707
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Country | US
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Telephone | 434-841-4251
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Fax | 512-688-5073
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Provider Business Mailing Address
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Address Line | 1229 LEANDER RD
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City | GEORGETOWN
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State | TX
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Zip | 78628-8707
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Country | US
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Telephone | 512-872-4200
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Fax | 512-688-5073
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401006597
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30666
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License Number State | TX
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