Provider Demographics
NPI:1215545827
Name:BEAR, DOMINICK EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:EDWARD
Last Name:BEAR
Suffix:
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 1:437 SANTEE DR
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:SC
Mailing Address - Zip Code:29142-9304
Mailing Address - Country:US
Mailing Address - Phone:309-313-2980
Mailing Address - Fax:
Practice Address - Street 1:102 BRYANT ST
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-2160
Practice Address - Country:US
Practice Address - Phone:843-563-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC96751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice