Healthcare Provider Details

I. General information

NPI: 1770976763
Provider Name (Legal Business Name): BMH DENTISTRY, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2015
Last Update Date: 03/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 HIGHWAY 53 W
DAWSONVILLE GA
30534-3411
US

IV. Provider business mailing address

754 HIGHWAY 53 W
DAWSONVILLE GA
30534-3411
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDN014918
License Number StateGA

VIII. Authorized Official

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