MEDICARE: DR. MICHAEL JAY BEHNEN DDS

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	1223E0200X	Endodontics	DE00009702	WA

General Provider Information

NPI Number	:	1770813693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JAY BEHNEN DDS

Provider Business Mailing Address
First Line	:	408 LILLY RD NE STE A
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-6954
Country	:	US
Telephone Number	:	360-459-3636
Fax Number	:	360-459-0343

Provider Business Practice Location Address
First Line	:	408 LILLY RD NE STE A
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-6954
Country	:	US
Telephone Number	:	360-459-3636
Fax Number	:	360-459-0343

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

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	12/29/2009

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