Provider Demographics
NPI:1871747832
Name:BIVENS DENTAL GROUP PC
Entity type:Organization
Organization Name:BIVENS DENTAL GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-670-5961
Mailing Address - Street 1:5103 HIGHWAY 100
Mailing Address - Street 2:
Mailing Address - City:LYLES
Mailing Address - State:TN
Mailing Address - Zip Code:37098-1879
Mailing Address - Country:US
Mailing Address - Phone:931-670-5961
Mailing Address - Fax:
Practice Address - Street 1:5103 HIGHWAY 100
Practice Address - Street 2:
Practice Address - City:LYLES
Practice Address - State:TN
Practice Address - Zip Code:37098-1879
Practice Address - Country:US
Practice Address - Phone:931-670-5961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIVENS DENTAL GROUP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-04
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6858261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental