Individual
DR. BRUCE EDISON BENTLEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1229 LEANDER RD, GEORGETOWN, TX 78628-8707
(434) 841-4251
(512) 688-5073
Mailing address
1229 LEANDER RD, GEORGETOWN, TX 78628-8707
(512) 872-4200
(512) 688-5073
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401006597
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
30666
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13823
—
VA
Enumeration date
01/09/2007
Last updated
06/23/2023
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