Provider Demographics
NPI:1679522759
Name:BIFANO, MARTIN JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:JAMES
Last Name:BIFANO
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 1:957 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSON
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1243
Mailing Address - Country:US
Mailing Address - Phone:570-282-1387
Mailing Address - Fax:570-281-6188
Practice Address - Street 1:957 MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSON
Practice Address - State:PA
Practice Address - Zip Code:18407-1243
Practice Address - Country:US
Practice Address - Phone:570-282-1387
Practice Address - Fax:570-281-6188
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023163L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice