Provider Demographics
NPI:1053561035
Name:BIENSTOCK, LISA BETH (DMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:BETH
Last Name:BIENSTOCK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 E CAMELBACK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4126
Mailing Address - Country:US
Mailing Address - Phone:602-903-4894
Mailing Address - Fax:602-675-9843
Practice Address - Street 1:1934 E CAMELBACK RD STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4126
Practice Address - Country:US
Practice Address - Phone:602-903-4894
Practice Address - Fax:602-675-9843
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP57185122300000X
AZD7308122300000X
NY0543981223P0221X
AZD073081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ080451Medicaid