Provider Demographics
NPI:1235593385
Name:BRIAN A BAIN DDS II PC
Entity Type:Organization
Organization Name:BRIAN A BAIN DDS II PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-258-5516
Mailing Address - Street 1:429 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:BOWDON
Mailing Address - State:GA
Mailing Address - Zip Code:30108-1405
Mailing Address - Country:US
Mailing Address - Phone:770-258-5516
Mailing Address - Fax:
Practice Address - Street 1:831 DIXIE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4415
Practice Address - Country:US
Practice Address - Phone:770-832-9668
Practice Address - Fax:678-601-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0142781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty