Michael Bentley, DDS
Individual provider Active NPI General Practice Dentistry · Creve Coeur, IL
NPI 1194883389 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1194883389
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Practice address
- 632 S Main St
Creve Coeur, IL 61610-3974 - Phone
- (309) 698-0220
- Fax
- (309) 698-0231
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019016488 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michael J Bentley DDS LTD | General Practice | Past | Accepting new patients |
| Edp of Illinois P.C | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Yes |
Addresses
Primary practice location
632 S Main St
Creve Coeur, IL 61610-3974
Mailing address
632 S Main St
Creve Coeur, IL 61610-3974
Phone (309) 698-0220
Other providers in Creve Coeur, IL
- Daniel H Brune
- Daniel Robert Brune
- Dennis Lane Conway
- Creve Coeur School Dist No 76
- Heinz Creve Coeur Pharmacy Inc
All providers in Creve Coeur, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.