Provider Demographics
NPI:1114002169
Name:GEORGE DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:GEORGE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER GEORGE DENTAL ASSOCIATES
Authorized Official - Prefix:
Authorized Official - First Name:MALLARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:724-437-7562
Mailing Address - Street 1:540 MORGANTOWN STREET
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401
Mailing Address - Country:US
Mailing Address - Phone:724-437-7562
Mailing Address - Fax:724-437-0332
Practice Address - Street 1:540 MORGANTOWN STREET
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-437-7562
Practice Address - Fax:724-437-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty