Provider Demographics
NPI:1033809272
Name:GEORGE, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 CINNAMON FERN CT
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5812
Mailing Address - Country:US
Mailing Address - Phone:407-310-3464
Mailing Address - Fax:
Practice Address - Street 1:100 E 15TH ST STE 520
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-6566
Practice Address - Country:US
Practice Address - Phone:817-529-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN28207122300000X
TX39869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist