Provider Demographics
NPI:1730767138
Name:BENTLEY, MARK (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1740 STATE ROUTE 139
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-8887
Mailing Address - Country:US
Mailing Address - Phone:740-370-2667
Mailing Address - Fax:
Practice Address - Street 1:2145 N FAIRFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2783
Practice Address - Country:US
Practice Address - Phone:937-588-3900
Practice Address - Fax:937-558-3999
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXV3832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine