Provider Demographics
NPI:1669495438
Name:BODENSTEINER, MICHAEL T (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:BODENSTEINER
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 1:4148 S. DEMAREE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277
Mailing Address - Country:US
Mailing Address - Phone:559-635-0900
Mailing Address - Fax:559-635-0700
Practice Address - Street 1:4148 S. DEMAREE ST
Practice Address - Street 2:SUITE A
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-635-0900
Practice Address - Fax:559-635-0700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice