Provider Demographics
NPI:1205383726
Name:DAHDAL, GEORYOS (DDS)
Entity Type:Individual
Prefix:
First Name:GEORYOS
Middle Name:
Last Name:DAHDAL
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 1:103 MEETING HALL DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5541
Mailing Address - Country:US
Mailing Address - Phone:919-234-6175
Mailing Address - Fax:
Practice Address - Street 1:15 RAWLS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501
Practice Address - Country:US
Practice Address - Phone:919-639-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist