MEDICARE: BIVENS DENTISTRY, PLLC

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

General Provider Information

NPI Number	:	1508751827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIVENS DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	660 S MOUNT JULIET RD STE 200
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3970
Country	:	US
Telephone Number	:	615-773-8882
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 S MOUNT JULIET RD STE 200
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3970
Country	:	US
Telephone Number	:	615-773-8882
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	PETER BILAN
Credential	:
Telephone Number	:	941-232-8433

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	06/09/2025

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