Provider Demographics
NPI:1073722716
Name:JANEWAY, GEORGE E JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:JANEWAY
Suffix:JR
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 1:2238 BAYVIEW HEIGHTS DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3921
Mailing Address - Country:US
Mailing Address - Phone:805-528-3000
Mailing Address - Fax:805-528-3080
Practice Address - Street 1:2238 BAYVIEW HEIGHTS DR
Practice Address - Street 2:SUITE F
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3921
Practice Address - Country:US
Practice Address - Phone:805-528-3000
Practice Address - Fax:805-528-3080
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB21373-01OtherMEDI-CAL PROVIDER NUMBER