Provider Demographics
NPI:1316642036
Name:ITMER, BEMISAL (DDS)
Entity type:Individual
Prefix:MISS
First Name:BEMISAL
Middle Name:
Last Name:ITMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 ARIZONA
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-2849
Mailing Address - Country:US
Mailing Address - Phone:214-680-6376
Mailing Address - Fax:
Practice Address - Street 1:3080 N EASTMAN RD STE 104
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7978
Practice Address - Country:US
Practice Address - Phone:214-680-6376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX406201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program