Provider Demographics
NPI:1790933414
Name:BINGHAM, MICHAEL ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERIC
Last Name:BINGHAM
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 1:4609 S TIMBERLINE RD STE 104B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3171
Mailing Address - Country:US
Mailing Address - Phone:970-498-0196
Mailing Address - Fax:970-498-0327
Practice Address - Street 1:4609 S TIMBERLINE RD STE 104B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3171
Practice Address - Country:US
Practice Address - Phone:970-498-0196
Practice Address - Fax:970-498-0327
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT73742909922122300000X
CADDS1009081223S0112X
CODEN.00204287204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery