Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D7308 | AZ |
N | 122300000X | Dentist | P57185 | NY |
N | 1223P0221X | Pediatric Dentist | 054398 | NY |
NPI | 1053561035 |
---|---|
Provider Name | Lisa Beth Bienstock |
First Address | Scottsdale, AZ 85251-1491 |
Second Address | Phoenix, AZ 85022-6337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2008 |
Last Update Date | 23/09/2015 |