Provider Demographics
NPI:1164678173
Name:GEORGE, GINCY THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:GINCY
Middle Name:THOMAS
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 1:1328 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5645
Mailing Address - Country:US
Mailing Address - Phone:732-363-5558
Mailing Address - Fax:
Practice Address - Street 1:1328 ROUTE 9
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5645
Practice Address - Country:US
Practice Address - Phone:732-363-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-09
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023845001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry