Provider Demographics
NPI:1053480764
Name:BIVENS, SHAUN MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:MICHAEL
Last Name:BIVENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 N MOUNT JULIET RD STE 2302
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3872
Mailing Address - Country:US
Mailing Address - Phone:615-773-8882
Mailing Address - Fax:615-758-2383
Practice Address - Street 1:541 N MOUNT JULIET RD STE 2302
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3872
Practice Address - Country:US
Practice Address - Phone:615-773-8882
Practice Address - Fax:615-758-2383
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice