Dr Damaris Bastian Gen.dent. Llc | |
101 Devant St Ste 404 Fayetteville GA 30214-2713 | |
(678) 884-5352 | |
Not Available |
Full Name | Dr Damaris Bastian Gen.dent. Llc |
---|---|
Speciality | Dentist |
Location | 101 Devant St Ste 404, Fayetteville, Georgia |
Authorized Official Name and Position | Damaris Derece Bastian (OWNER) |
Authorized Official Contact | 6788845352 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Dr Damaris Bastian Gen.dent. Llc 101 Devant St Ste 404 Fayetteville GA 30214-2713 Ph: (678) 884-5352 | Dr Damaris Bastian Gen.dent. Llc 101 Devant St Ste 404 Fayetteville GA 30214-2713 Ph: (678) 884-5352 |
NPI Number | 1609089002 |
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Provider Enumeration Date | 05/08/2007 |
Last Update Date | 11/08/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609089002 | NPI | - | NPPES |
1850870 | Medicaid | LA | |
4334104830 | Other | LA | BLUE CROSS BLUE SHEILD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 5087 (Louisiana) | Primary |
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