Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN19321 | FL |
N | 1223G0001X | General Practice | DN 19321 | FL |
N | 213EG0000X | General Practice | DN 19321 | FL |
NPI | 1144516287 |
---|---|
Provider Name | Dr. Russell David Bienias |
First Address | Eglin Afb, FL 32542 |
Second Address | Eglin Afb, FL 32542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 22/09/2020 |