Provider Demographics
NPI:1104906346
Name:GEERLINGS, BRYAN SCOTT (DMD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:SCOTT
Last Name:GEERLINGS
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 1:91 JEFFERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-5813
Mailing Address - Country:US
Mailing Address - Phone:770-502-0350
Mailing Address - Fax:770-502-0135
Practice Address - Street 1:91 JEFFERSON PKWY
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-5813
Practice Address - Country:US
Practice Address - Phone:770-502-0350
Practice Address - Fax:770-502-0135
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics