Provider Demographics
NPI:1033276126
Name:FARINACCI, GEORGE CLEMENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CLEMENT
Last Name:FARINACCI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CLOVERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-2449
Mailing Address - Country:US
Mailing Address - Phone:210-658-3508
Mailing Address - Fax:210-658-0299
Practice Address - Street 1:97 CLOVERLEAF DR
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-2449
Practice Address - Country:US
Practice Address - Phone:210-658-3508
Practice Address - Fax:210-658-0299
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX976334Medicare UPIN
VA383143Medicare UPIN
TXD15614Medicare UPIN