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Danette
D
Bentley
MD
Contract Details
Bentley Dermatology & Skin Wellness
Facility name
Provider ID
P000000122
NPI
1407060056
Tax ID
841721113
Effective Date
1/1/1996
Last Updated
11/21/2011
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
5295 Perserve Pkwy Suite 260
Hoover, AL 35244
United States
County
Jefferson
Phone
2056828022
(
Phone
)
Billing Details
Address
Specialty Type
Dermatology
Map
Address