Provider Demographics
NPI:1043727548
Name:ROCKY MOUNTAIN DENTAL SLEEP, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN DENTAL SLEEP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-807-2083
Mailing Address - Street 1:1632 S JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2811
Mailing Address - Country:US
Mailing Address - Phone:574-807-2083
Mailing Address - Fax:
Practice Address - Street 1:7502 W 80TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2139
Practice Address - Country:US
Practice Address - Phone:303-421-2696
Practice Address - Fax:303-421-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO202272122300000X
CO201891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty