Provider Demographics
NPI:1225236680
Name:GEORGE P. NAJIM DDS PC
Entity Type:Organization
Organization Name:GEORGE P. NAJIM DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SCRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-647-5150
Mailing Address - Street 1:30 NORTH MAIN STREET
Mailing Address - Street 2:P O BOX 775
Mailing Address - City:AUSABLE FORKS
Mailing Address - State:NY
Mailing Address - Zip Code:12912
Mailing Address - Country:US
Mailing Address - Phone:518-647-5150
Mailing Address - Fax:518-647-8899
Practice Address - Street 1:30 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:AUSABLE FORKS
Practice Address - State:NY
Practice Address - Zip Code:12912
Practice Address - Country:US
Practice Address - Phone:518-647-5150
Practice Address - Fax:518-647-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52640431OtherDENTAL
NY1902873029OtherNPI#
NY1223G0001XOtherTAXONOMIES
NYAN5177894OtherDENTAL
NY0062503Medicaid
NY26776OtherLICENSE #