Provider Demographics
NPI:1497774038
Name:BMH DENTISTRY, PC
Entity Type:Organization
Organization Name:BMH DENTISTRY, PC
Other - Org Name:DAWSONVILLE DISTINCTIVE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-265-2505
Mailing Address - Street 1:P.O. BOX 182
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534
Mailing Address - Country:US
Mailing Address - Phone:706-265-2505
Mailing Address - Fax:706-265-6007
Practice Address - Street 1:754 HWY 53 W
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534
Practice Address - Country:US
Practice Address - Phone:706-265-2505
Practice Address - Fax:706-265-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0149181223G0001X
DN0149181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty