Provider Demographics
NPI:1518445683
Name:BETHLEHEM DENTISTRY, LLC
Entity Type:Organization
Organization Name:BETHLEHEM DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:ESCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-963-5790
Mailing Address - Street 1:255 GATEWAY DRIVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620
Mailing Address - Country:US
Mailing Address - Phone:678-963-5790
Mailing Address - Fax:678-963-5591
Practice Address - Street 1:255 GATEWAY DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620
Practice Address - Country:US
Practice Address - Phone:678-963-5790
Practice Address - Fax:678-963-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty