Individual
MARK BENTLEY BLEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1001 W BROADWAY STE D, FARMINGTON, NM 87401-5638
(505) 325-9133
Mailing address
1001 W BROADWAY STE D, FARMINGTON, NM 87401-5638
(505) 325-9133
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD2905
NM
Other
Enumeration date
07/26/2007
Last updated
07/26/2007
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