Provider Demographics
NPI:1114933801
Name:TRASK, GEORGE LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LEE
Last Name:TRASK
Suffix:
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 1:136 NORTH RIDGE ST
Mailing Address - Street 2:STE C
Mailing Address - City:MONROEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44847-9428
Mailing Address - Country:US
Mailing Address - Phone:419-465-2574
Mailing Address - Fax:419-465-2598
Practice Address - Street 1:136 NORTH RIDGE ST
Practice Address - Street 2:STE C
Practice Address - City:MONROEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44847-9428
Practice Address - Country:US
Practice Address - Phone:419-465-2574
Practice Address - Fax:419-465-2598
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30018914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2678526Medicaid