Provider Demographics
NPI:1235333519
Name:GEORGE KEVORKIAN JR DDS PC
Entity Type:Organization
Organization Name:GEORGE KEVORKIAN JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEVORKIAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-344-7252
Mailing Address - Street 1:895 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-2105
Mailing Address - Country:US
Mailing Address - Phone:540-344-7252
Mailing Address - Fax:540-345-1891
Practice Address - Street 1:895 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-2105
Practice Address - Country:US
Practice Address - Phone:540-344-7252
Practice Address - Fax:540-345-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010066561223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty