Preston G Bivona, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7297 Issued in LA

Practice address

480 Oak Harbor Blvd
Slidell, LA 70458-8817

Phone

(985) 649-9455

NPI assigned

Jun 1, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1942949730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "436 TIGER AVE",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704335261",
            "telephone_number": "504-919-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 OAK HARBOR BLVD",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704588817",
            "telephone_number": "985-649-9455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIVONA",
        "first_name": "PRESTON",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-01",
        "last_updated": "2022-06-01",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "7297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XHB731919725",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fred L Birmingham, O.D.
• Laurie Ann Bishop, M.D.
• Ashlen Bissell, DPT
• Saumitra Biswas, MD
• Jasmine Bivins
• Black Women DO Heal, Inc
• Blakk Diamond LLC
• Craig James Blalock, DC
• Dalmer A Blanchard, LCSW
• Shelly A Blanchard, LCSW

• General Practice Dentistry in Slidell, LA
• Providers in Slidell, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.