Provider Demographics
NPI:1104155902
Name:MANZUR, BILAL (DMD)
Entity type:Individual
Prefix:MR
First Name:BILAL
Middle Name:
Last Name:MANZUR
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:P.O. BOX 182
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534
Mailing Address - Country:US
Mailing Address - Phone:706-265-2505
Mailing Address - Fax:706-265-6007
Practice Address - Street 1:754 HWY 53 W
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534
Practice Address - Country:US
Practice Address - Phone:706-265-2505
Practice Address - Fax:706-265-6007
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN188651223G0001X
GADN0149181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice