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Organization

BRIAN M. BIVENS, DMD, MS, PA

Active
Other names
Bay Dental Specialists
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRIAN M. BIVENS DMD (PRESIDENT)
(813) 443-5050
Entity
Organization

Contact information

Practice address
12950 RACE TRACK RD, SUITE 107, TAMPA, FL 33626-1309
(813) 443-5050
(813) 749-7526
Mailing address
12950 RACE TRACK RD, SUITE 107, TAMPA, FL 33626-1309
(813) 443-5050
(813) 749-7526

Taxonomy

Speciality
Code
Description
License number
State
1223E0200X
Endodontics
1223P0221X
Pediatric Dentistry
1223P0300X
Periodontics
DN6295
FL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN16668
FL
124Q00000X
Dental Hygienist
DH15021
FL

Other

Enumeration date
02/15/2011
Last updated
02/15/2011
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