Individual
DR. MARK WILLAM BANTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
820 E COLFAX AVE, SOUTH BEND, IN 46617-2804
(574) 234-4117
(574) 289-3631
Mailing address
820 E COLFAX AVE, SOUTH BEND, IN 46617-2804
(574) 234-4117
(574) 289-3631
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7086
IN
Other
Enumeration date
04/28/2009
Last updated
04/28/2009
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