Provider Demographics
NPI:1215769252
Name:MOUNTAIN VIEW DENTAL PC
Entity type:Organization
Organization Name:MOUNTAIN VIEW DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-807-2083
Mailing Address - Street 1:1632 S JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2811
Mailing Address - Country:US
Mailing Address - Phone:574-807-2083
Mailing Address - Fax:
Practice Address - Street 1:3601 S CLARKSON ST STE 320
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3969
Practice Address - Country:US
Practice Address - Phone:303-762-9575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental