Bruce Philip Benifiel, D.D.S.
Individual provider Active NPI General Practice Dentistry · Granger, IN
NPI 1720171077 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720171077
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12008886 (IN)
- Practice address
- 925 E University Dr
Granger, IN 46530-4465 - Phone
- (574) 277-7733
- Fax
- (574) 277-8436
- NPI assigned
- Oct 1, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160826002411 | IN | Order and Referring Only - Dentist |
2163717372 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12008886 | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bruce P. Benifiel, D.D.S., P.C. | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12008886 | IN | Yes |
Addresses
Primary practice location
925 E University Dr
Granger, IN 46530-4465
Mailing address
925 E University Dr
Granger, IN 46530-4465
Phone (574) 277-7733
Other providers in Granger, IN
- Beacon Medical Group, Inc.
- Beacon Medical Group, Inc.
- Mason I Beall
- Beds by George, Inc.
- John Jacob Bell
- Beyond Zen Enterprises Inc.
- Sherri Jo Biever
- Joanne Ilias Bilionis
- Bittersweet Rd. Family Dentist
- Black Clover Holdings LLC
All providers in Granger, IN · General Practice Dentistry in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.