Individual
DR. BENTLEY JAMES ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
621 S NEW BALLAS RD STE 16A, SAINT LOUIS, MO 63141-8239
(314) 251-6725
Mailing address
621 S NEW BALLAS RD STE 16A, SAINT LOUIS, MO 63141-8239
(314) 251-6725
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2021011403
MO
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
2021011403
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2017
Last updated
07/07/2021
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