Provider Demographics
NPI:1386627131
Name:BIENENSTOCK, MARTIN (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:BIENENSTOCK
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 OCEAN PKWY
Mailing Address - Street 2:2-G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8250
Mailing Address - Country:US
Mailing Address - Phone:718-996-0300
Mailing Address - Fax:718-996-0089
Practice Address - Street 1:2940 OCEAN PKWY
Practice Address - Street 2:2-G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8250
Practice Address - Country:US
Practice Address - Phone:718-996-0300
Practice Address - Fax:718-996-0089
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDDS247421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice