MEDICARE: DR. LISA BETH BIENSTOCK 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	122300000X	Dentist	D7308	AZ
2	1223P0221X	Pediatric Dentistry	054398	NY
3	1223P0221X	Pediatric Dentistry	D07308	AZ
4	122300000X	Dentist	P57185	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053561035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA BETH BIENSTOCK D.M.D

Provider Business Mailing Address
First Line	:	1934 E CAMELBACK RD STE 110
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4136
Country	:	US
Telephone Number	:	602-903-4894
Fax Number	:	602-675-9843

Provider Business Practice Location Address
First Line	:	1934 E CAMELBACK RD STE 110
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4126
Country	:	US
Telephone Number	:	602-903-4894
Fax Number	:	602-675-9843

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

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	06/09/2026

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