MEDICARE: DR. SHAUN MICHAEL BIVENS D.M.D.

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	1223G0001X	General Practice Dentistry	8528	TN

General Provider Information

NPI Number	:	1053480764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAUN MICHAEL BIVENS D.M.D.

Provider Business Mailing Address
First Line	:	541 N MOUNT JULIET RD STE 2302
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3872
Country	:	US
Telephone Number	:	615-773-8882
Fax Number	:	615-758-2383

Provider Business Practice Location Address
First Line	:	541 N MOUNT JULIET RD STE 2302
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3872
Country	:	US
Telephone Number	:	615-773-8882
Fax Number	:	615-758-2383

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/23/2010

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