Provider Demographics
NPI:1154453819
Name:GEORGE, MARY LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LYNN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:173 EAST SHORE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023
Mailing Address - Country:US
Mailing Address - Phone:516-487-8110
Mailing Address - Fax:516-487-8394
Practice Address - Street 1:173 EAST SHORE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023
Practice Address - Country:US
Practice Address - Phone:516-487-8110
Practice Address - Fax:516-487-8394
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYNY0341961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry