Provider Demographics
NPI:1902894199
Name:BENTLEY, JAMES ARTHUR JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ARTHUR
Last Name:BENTLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4633 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4022
Mailing Address - Country:US
Mailing Address - Phone:214-520-7444
Mailing Address - Fax:214-443-7525
Practice Address - Street 1:4633 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-4022
Practice Address - Country:US
Practice Address - Phone:214-520-7444
Practice Address - Fax:214-443-7525
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6725207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C13376Medicare UPIN
TX00J439Medicare PIN