Provider Demographics
NPI:1225372857
Name:GEORGE, SUSAN THOMAS
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:THOMAS
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 GARDEN SAGE DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4619
Mailing Address - Country:US
Mailing Address - Phone:478-290-3850
Mailing Address - Fax:
Practice Address - Street 1:1013 LOCKWOOD BLVD
Practice Address - Street 2:UNIT#7
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6001
Practice Address - Country:US
Practice Address - Phone:407-278-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist