Provider Demographics
NPI:1659732980
Name:GEORGE A BARE JR DMD PLLC
Entity Type:Organization
Organization Name:GEORGE A BARE JR DMD PLLC
Other - Org Name:RESTORATIVE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:931-648-0604
Mailing Address - Street 1:237 DUNBAR CAVE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8852
Mailing Address - Country:US
Mailing Address - Phone:931-648-0604
Mailing Address - Fax:931-648-0605
Practice Address - Street 1:237 DUNBAR CAVE RD
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8852
Practice Address - Country:US
Practice Address - Phone:931-648-0604
Practice Address - Fax:931-648-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000046461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty