Healthcare Provider Details

I. General information

NPI: 1740624493
Provider Name (Legal Business Name): DANIEL P. BITNER, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 NE WILLIAMSON BLVD
BEND OR
97701-6071
US

IV. Provider business mailing address

1590 NE WILLIAMSON BLVD
BEND OR
97701-6071
US

V. Phone/Fax

Practice location:
  • Phone: 541-388-1500
  • Fax: 541-388-6995
Mailing address:
  • Phone: 541-388-1500
  • Fax: 541-388-6995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8852
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DANIEL POULSON BITNER
Title or Position: OWNER
Credential: DMD
Phone: 541-388-1500