Provider Demographics
NPI:1538900113
Name:BINGHAM, DE'QUINCY (DDS, MSPH, MHS)
Entity type:Individual
Prefix:
First Name:DE'QUINCY
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:DDS, MSPH, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 JACKSON ST NE APT 3214
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-7919
Mailing Address - Country:US
Mailing Address - Phone:615-586-1916
Mailing Address - Fax:
Practice Address - Street 1:2239 HIGHWAY 20 SE STE H
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2087
Practice Address - Country:US
Practice Address - Phone:770-921-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123513122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist