Healthcare Provider Details

I. General information

NPI: 1497774038
Provider Name (Legal Business Name): BMH DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 HWY 53 W
DAWSONVILLE GA
30534
US

IV. Provider business mailing address

P.O. BOX 182
DAWSONVILLE GA
30534
US

V. Phone/Fax

Practice location:
  • Phone: 706-265-2505
  • Fax: 706-265-6007
Mailing address:
  • Phone: 706-265-2505
  • Fax: 706-265-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN014918
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN014918
License Number State

VIII. Authorized Official

Name: BILAL MANZUR
Title or Position: OFFICER
Credential: D.M.D.
Phone: 706-265-2505