Provider Demographics
NPI:1225031735
Name:GEORGE, MARK A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:GEORGE
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 1:1140 W LA VETA AVE
Mailing Address - Street 2:STE 530
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4227
Mailing Address - Country:US
Mailing Address - Phone:714-953-1000
Mailing Address - Fax:714-953-9957
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:STE 530
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4227
Practice Address - Country:US
Practice Address - Phone:714-953-1000
Practice Address - Fax:714-953-9957
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
CA311421223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics