Provider Demographics
NPI:1073522280
Name:TONI B. GEORGIADES, DDS, APC
Entity Type:Organization
Organization Name:TONI B. GEORGIADES, DDS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TORI
Authorized Official - Middle Name:B
Authorized Official - Last Name:GEORGIADES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-753-6124
Mailing Address - Street 1:317 N EL CAMINO REAL SUITE 406
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2815
Mailing Address - Country:US
Mailing Address - Phone:760-753-6124
Mailing Address - Fax:760-753-7241
Practice Address - Street 1:317 N EL CAMINO REAL STE 406
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2815
Practice Address - Country:US
Practice Address - Phone:760-753-6124
Practice Address - Fax:760-753-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty