Provider Demographics
NPI:1619955135
Name:BINGHAM, GEORGE JOINER (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOINER
Last Name:BINGHAM
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:BDC ATSUGI
Mailing Address - Street 2:PSC 477 BOX 2
Mailing Address - City:NAF ATSUGI
Mailing Address - State:FPO
Mailing Address - Zip Code:AP
Mailing Address - Country:JP
Mailing Address - Phone:8146-763-3340
Mailing Address - Fax:
Practice Address - Street 1:BDC ATSUGI
Practice Address - Street 2:PSC 477 BOX 2
Practice Address - City:NAF ATSUGI
Practice Address - State:FPO
Practice Address - Zip Code:AP
Practice Address - Country:JP
Practice Address - Phone:8146-763-3340
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 11032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist