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General NPI Number Information
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NPI Number | 1043727548
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN DENTAL SLEEP, LLC
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 7502 W 80TH AVE STE 100
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City | ARVADA
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State | CO
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Zip | 80003-2139
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Country | US
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Telephone | 303-421-2696
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Fax | 303-421-2179
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Provider Business Mailing Address
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Address Line | 1632 S JOSEPHINE ST
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City | DENVER
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State | CO
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Zip | 80210-2811
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Country | US
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Telephone | 574-807-2083
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES BIENEMAN
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Credential | DDS
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Telephone | 574-807-2083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 202272
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 201891
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License Number State | CO
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