Provider Demographics
NPI:1114133063
Name:BIENSTOCK, BARRY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:A
Last Name:BIENSTOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-447-2235
Mailing Address - Fax:860-444-2992
Practice Address - Street 1:177 BOSTON POST ROAD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-0254
Practice Address - Country:US
Practice Address - Phone:860-447-2235
Practice Address - Fax:860-444-2992
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist