MEDICARE: RANDY LEE BISPING DDS MS PC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	014916	MI

General Provider Information

NPI Number	:	1134165376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY LEE BISPING DDS MS PC

Provider Business Mailing Address
First Line	:	3579 HENRY
Second Line	:	SUITE 140
City	:	MUSKEGON
State	:	MI
Zip	:	49441
Country	:	US
Telephone Number	:	231-739-1215
Fax Number	:	231-737-2347

Provider Business Practice Location Address
First Line	:	3579 HENRY
Second Line	:	SUITE 140
City	:	MUSKEGON
State	:	MI
Zip	:	49441
Country	:	US
Telephone Number	:	231-739-1215
Fax Number	:	231-737-2347

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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