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NPI Code Detail

MEDICARE: BRIAN BIENSTOCK PLLC

MEDICARE: BRIAN BIENSTOCK 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
1122300000XDentist4549NV

General Provider Information

NPI Number : 1972853109
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIAN BIENSTOCK PLLC
Provider Business Mailing Address
First Line : 1070 N. RANCHO DR.
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106
Country : US
Telephone Number : 702-648-3701
Fax Number : 702-453-6669
Provider Business Practice Location Address
First Line : 1070 N. RANCHO DR.
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106
Country : US
Telephone Number : 702-648-3701
Fax Number : 702-453-6669
Authorized Official
Title or Position : DENTIST / OWNER
Name : BRIAN SCOTT BIENSTOCK
Credential : DDS
Telephone Number : 702-281-8224
Provider Enumeration Date : 09/14/2012
Last Update Date : 09/14/2012

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