Provider Demographics
NPI:1083415475
Name:BISON DENTAL PC
Entity type:Organization
Organization Name:BISON DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CARYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-403-7044
Mailing Address - Street 1:85 ARGONAUT STE 220
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4105
Mailing Address - Country:US
Mailing Address - Phone:949-403-7044
Mailing Address - Fax:
Practice Address - Street 1:2700 CACTUS DR
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-6003
Practice Address - Country:US
Practice Address - Phone:580-262-8900
Practice Address - Fax:949-607-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty