MEDICARE: CHAD MICHAEL BIERBAUM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30-023717	OH

General Provider Information

NPI Number	:	1144583717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD MICHAEL BIERBAUM DDS

Provider Business Mailing Address
First Line	:	11907 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-1726
Country	:	US
Telephone Number	:	513-697-1211
Fax Number	:	513-697-1214

Provider Business Practice Location Address
First Line	:	11907 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-1726
Country	:	US
Telephone Number	:	513-697-1211
Fax Number	:	513-697-1214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	06/19/2012

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