Provider Demographics
NPI:1083928873
Name:BAWAK DESIR, GERMAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERMAINE
Middle Name:
Last Name:BAWAK DESIR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 MCMILLAN POINT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-7678
Mailing Address - Country:US
Mailing Address - Phone:706-831-1453
Mailing Address - Fax:
Practice Address - Street 1:409 W SOLOMON STREET
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-3563
Practice Address - Country:US
Practice Address - Phone:678-688-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist