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Individual

DANIEL A BENTLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
1401 E STATE ST, ROCKFORD, IL 61104-2315
(815) 391-6102
Mailing address
95 COLLIER RD, SUITE 5015, ATLANTA, GA 30309
(404) 605-2800

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085.004313
IL
363AS0400X
Surgical Physician Assistant
PA9104555
FL

Other

Enumeration date
09/22/2006
Last updated
06/28/2013
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