MEDICARE: RANDY L 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)	2901014916	MI

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	:	1174892772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDY L BISPING DDS MS PC

Provider Business Mailing Address
First Line	:	3579 HENRY ST
Second Line	:	SUITE 140
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-6720
Country	:	US
Telephone Number	:	231-739-1215
Fax Number	:	231-737-2347

Provider Business Practice Location Address
First Line	:	3579 HENRY ST
Second Line	:	SUITE 140
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-6720
Country	:	US
Telephone Number	:	231-739-1215
Fax Number	:	231-737-2347

Authorized Official
Title or Position	:	ORAL SURGEON
Name	:	DR. RANDY LEE BISPING
Credential	:	D.D.S.M.S.P.C.
Telephone Number	:	231-739-1215

Provider Enumeration Date	:	12/28/2011
Last Update Date	:	03/13/2012

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