Provider Demographics
NPI:1336431865
Name:BIENSTOCK, DANIEL (MD, DMD, FACS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:BIENSTOCK
Suffix:
Gender:M
Credentials:MD, DMD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 IRVING PL STE 2
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1245
Mailing Address - Country:US
Mailing Address - Phone:516-569-6311
Mailing Address - Fax:
Practice Address - Street 1:150 IRVING PL STE 2
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1245
Practice Address - Country:US
Practice Address - Phone:516-569-6311
Practice Address - Fax:516-569-6312
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289284208600000X
NY0591161223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery