Bruce Edison Bentley Jr., D.D.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

30666 Issued in TX

Practice address

1229 Leander Rd
Georgetown, TX 78628-8707

Phone

(434) 841-4251

Fax

(512) 688-5073

NPI assigned

Jan 9, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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.

• Georgetown Orthodontics PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Georgetown, TX
  • NPI 1245118751

  Orthodontics and Dentofacial Orthopedics

  NPD

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1740339902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 LEANDER RD",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786288707",
            "telephone_number": "512-872-4200",
            "fax_number": "512-688-5073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 LEANDER RD",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786288707",
            "telephone_number": "434-841-4251",
            "fax_number": "512-688-5073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENTLEY",
        "first_name": "BRUCE",
        "middle_name": "EDISON",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "VA",
            "license": "0401006597",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "30666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13823",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara A Bender, LCSW
• Leah Marie Benedetti
• Julie Carr Benedict, LAC
• Stephen Douglas Benold, MD
• Melinda Benson
• Zachary Thomas Bequette, DPT
• Simin Berenji, PA
• Amanda Kathryn Beretta, D.O.
• Andrew Berg
• Paul Andrew Berg, MD

• All providers in Georgetown, TX
• Orthodontics and Dentofacial Orthopedics Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.