Provider Demographics
NPI:1558642819
Name:BEMIS, NATHANIEL LIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:LIN
Last Name:BEMIS
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 1:2210 REESE LN
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-1528
Mailing Address - Country:US
Mailing Address - Phone:801-310-7542
Mailing Address - Fax:
Practice Address - Street 1:2210 REESE LN
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-1528
Practice Address - Country:US
Practice Address - Phone:801-310-7542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice