Provider Demographics
NPI:1821120015
Name:DIMENSTIEN, MORTON BLAIR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MORTON
Middle Name:BLAIR
Last Name:DIMENSTIEN
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 1:6035 MABLETON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126
Mailing Address - Country:US
Mailing Address - Phone:770-948-9248
Mailing Address - Fax:770-948-9202
Practice Address - Street 1:6035 MABLETON PARKWAY
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126
Practice Address - Country:US
Practice Address - Phone:770-948-9248
Practice Address - Fax:770-948-9202
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6732122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist