MEDICARE: DR. JOHN WAYNE BENNION DDS, MD

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)	1516	MT
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	5246	MT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00053799	OTHER	MT	RR MEDICARE

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
3	41004	OTHER	MT	BCBS
4	5512234	OTHER	MT	CHIP

General Provider Information

NPI Number	:	1265530133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WAYNE BENNION DDS, MD

Provider Business Mailing Address
First Line	:	152 S 32ND ST W
Second Line	:	SUITE B
City	:	BILLINGS
State	:	MT
Zip	:	59102-6848
Country	:	US
Telephone Number	:	406-655-0170
Fax Number	:	406-655-2271

Provider Business Practice Location Address
First Line	:	152 S 32ND ST W
Second Line	:	SUITE B
City	:	BILLINGS
State	:	MT
Zip	:	59102-6848
Country	:	US
Telephone Number	:	406-655-0170
Fax Number	:	406-655-2271

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. JOHN WAYNE BENNION DDS, MD” Practice Location

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