Provider Demographics
NPI:1518993419
Name:BAIN, PETER T (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:BAIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 DELVERTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338
Mailing Address - Country:US
Mailing Address - Phone:404-252-8411
Mailing Address - Fax:404-252-1676
Practice Address - Street 1:2302 DELVERTON DRIVE
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:770-458-3897
Practice Address - Fax:404-252-1676
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice