Provider Demographics
NPI:1679515845
Name:BENTELE, MARK JOESPH (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOESPH
Last Name:BENTELE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2575 MONTEBELLO DR W STE 101
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6959
Mailing Address - Country:US
Mailing Address - Phone:719-268-7138
Mailing Address - Fax:719-599-5107
Practice Address - Street 1:2575 MONTEBELLO DR W STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6959
Practice Address - Country:US
Practice Address - Phone:719-268-7138
Practice Address - Fax:719-599-5107
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics