MEDICARE: DR. FARA BENDER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN15072	FL

General Provider Information

NPI Number	:	1215034962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARA BENDER DMD

Provider Business Mailing Address
First Line	:	6169 JOG RD
Second Line	:	SUITE B-5
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-6579
Country	:	US
Telephone Number	:	561-433-5544
Fax Number	:	561-433-4440

Provider Business Practice Location Address
First Line	:	6169 JOG RD
Second Line	:	SUITE B-5
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-6579
Country	:	US
Telephone Number	:	561-433-5544
Fax Number	:	561-433-4440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	07/08/2007

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