Basic Information
| Provider Information | |||||||||
| NPI: | 1164454575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BJUR | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2127 E VICTORY DR | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314043917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124436013 | ||||||||
| FaxNumber: | 9124436014 | ||||||||
| Practice Location | |||||||||
| Address1: | 2127 E VICTORY DR | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314043917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124436013 | ||||||||
| FaxNumber: | 9124436014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 03/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 3031 | SC | N | Dental Providers | Dentist | General Practice | 1223G0001X | DN010591 | GA | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 823966070 | 05 | GA | MEDICAID | ZX3031 | 05 | SC | MEDICAID |