Provider Demographics
NPI:1053534339
Name:BIENSTOCK, MARC HOWARD (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:HOWARD
Last Name:BIENSTOCK
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:325 E ALAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3050
Mailing Address - Country:US
Mailing Address - Phone:805-687-7902
Mailing Address - Fax:
Practice Address - Street 1:9 E PEDREGOSA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2416
Practice Address - Country:US
Practice Address - Phone:805-569-1889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOMS PERMIT #421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery