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General NPI Number Information
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NPI Number | 1144431776
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Entity Type | Organization
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Legal Business Name | PAUL E BACINO DDS PC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 132 S STARK ST
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City | BENNINGTON
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State | NE
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Zip | 68007
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Country | US
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Telephone | 402-238-2434
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Fax | 402-238-3230
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Provider Business Mailing Address
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Address Line | PO BOX 166
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City | BENNINGTON
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State | NE
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Zip | 68007-0166
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Country | US
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Telephone | 402-238-2434
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Fax | 402-238-3230
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL E BACINO
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Credential | DDS PC
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Telephone | 402-238-2434
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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 | 4986
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License Number State | NE
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