Provider Demographics
NPI:1093125270
Name:GEORGE, BRIAN (DMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CROSSINGS CIR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8592
Mailing Address - Country:US
Mailing Address - Phone:615-754-4444
Mailing Address - Fax:615-773-5975
Practice Address - Street 1:5000 CROSSINGS CIR
Practice Address - Street 2:SUITE 300
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8592
Practice Address - Country:US
Practice Address - Phone:615-754-4444
Practice Address - Fax:615-773-5975
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10065122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist