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
1	122300000X	Dentist	4549	NV

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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