Eric Michael Bender, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14847 Issued in MN

Practice address

17746 Kenwood TRL
Lakeville, MN 55044-9454

Phone

(952) 388-1778

Fax

(952) 388-1763

NPI assigned

Jun 22, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lakeville Modern Dentistry, PLLC

  • Dental Clinic/Center
  • Lakeville, MN
  • NPI 1992403919
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1194394288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17746 KENWOOD TRL",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449454",
            "telephone_number": "952-388-1778",
            "fax_number": "952-388-1763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17746 KENWOOD TRL",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449454",
            "telephone_number": "952-388-1778",
            "fax_number": "952-388-1763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENDER",
        "first_name": "ERIC",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-22",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN26108",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA DENTAL LICENSE",
            "identifier": "DN26108",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA DENTAL LICENSE",
            "identifier": "D14847",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea Bell, PHARM.D.
• Nicole Elizabeth Bellino
• Mark Kevin Bellows, LMFT
• Noel Therese Bellows, RN
• George Gordon Bemis Jr., M.D.
• Anna Benson
• Joseph John Bergstad, CPHT
• Erik Berquist, LPC
• Barry A Bershow, MD
• Best Wellness Care LLC

• General Practice Dentistry in Lakeville, MN
• Providers in Lakeville, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.