Provider Demographics
NPI:1053426403
Name:RE BIDINGER DDS JM STILES DMD PC
Entity type:Organization
Organization Name:RE BIDINGER DDS JM STILES DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-949-0002
Mailing Address - Street 1:14 CODY STREET
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570
Mailing Address - Country:US
Mailing Address - Phone:508-949-0002
Mailing Address - Fax:508-943-9310
Practice Address - Street 1:14 CODY STREET
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570
Practice Address - Country:US
Practice Address - Phone:508-949-0002
Practice Address - Fax:508-943-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168161223G0001X
MA171431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000384OtherDELTA
MAY51594OtherBCBS