Provider Demographics
NPI:1245383793
Name:BINNERSLEY, GEORGETTE B (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGETTE
Middle Name:B
Last Name:BINNERSLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GEORGETTE
Other - Middle Name:
Other - Last Name:BRAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1708 LOVERING AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2141
Mailing Address - Country:US
Mailing Address - Phone:302-652-5312
Mailing Address - Fax:302-652-8679
Practice Address - Street 1:1702 LOVERING AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-2120
Practice Address - Country:US
Practice Address - Phone:302-652-5312
Practice Address - Fax:302-652-8679
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE10941223G0001X
DEG1-00010941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1245383793Medicaid