Healthcare Provider Details

I. General information

NPI: 1609896851
Provider Name (Legal Business Name): MICHAEL GLENN BINGHAM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4538 SWAN LN
BILLINGS MT
59106-4707
US

IV. Provider business mailing address

4538 SWAN LN
BILLINGS MT
59106-4707
US

V. Phone/Fax

Practice location:
  • Phone: 208-851-1679
  • Fax:
Mailing address:
  • Phone: 208-851-1679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-3996
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1308
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD1177
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: