Provider Demographics
NPI:1275603482
Name:BIENSTOCK, BRIAN SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
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 1:4399 STEWART AVE
Mailing Address - Street 2:#140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-3238
Mailing Address - Country:US
Mailing Address - Phone:702-453-6660
Mailing Address - Fax:702-453-6669
Practice Address - Street 1:4399 STEWART AVE
Practice Address - Street 2:#140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3238
Practice Address - Country:US
Practice Address - Phone:702-453-6660
Practice Address - Fax:702-453-6669
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV45491223G0001X
WA60386595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501214Medicaid