Provider Demographics
NPI:1083048185
Name:JAMES BIENEMAN DDS PC
Entity Type:Organization
Organization Name:JAMES BIENEMAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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 1:6650 S. VINE ST
Mailing Address - Street 2:SUITE #220
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121
Mailing Address - Country:US
Mailing Address - Phone:303-797-0832
Mailing Address - Fax:303-797-0870
Practice Address - Street 1:6650 S. VINE ST
Practice Address - Street 2:SUITE #220
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121
Practice Address - Country:US
Practice Address - Phone:303-797-0832
Practice Address - Fax:303-797-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00201891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty