Provider Demographics
NPI:1033204433
Name:BARE, GEORGE ANTHONY JR (DMD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ANTHONY
Last Name:BARE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SOUTHAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2134
Mailing Address - Country:US
Mailing Address - Phone:615-618-0374
Mailing Address - Fax:
Practice Address - Street 1:237 DUNBAR CAVE RD STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8852
Practice Address - Country:US
Practice Address - Phone:931-648-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS46461223G0001X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies