MEDICARE: BENDER DENTAL LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1285194738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENDER DENTAL LLC

Provider Business Mailing Address
First Line	:	1713 N 3780 W
Second Line	:
City	:	LEHI
State	:	UT
Zip	:	84043-4198
Country	:	US
Telephone Number	:	801-230-1220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 E FORT UNION BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2859
Country	:	US
Telephone Number	:	801-943-3408
Fax Number	:	866-611-4680

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. MATTHEW STEPHEN BENDER
Credential	:	DMD
Telephone Number	:	801-230-1220

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	03/21/2019

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