Provider Demographics
NPI:1245753714
Name:SOURLIS, GEORGE PETER (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PETER
Last Name:SOURLIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3473 BRISTOL LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-7517
Mailing Address - Country:US
Mailing Address - Phone:443-798-1875
Mailing Address - Fax:
Practice Address - Street 1:418 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3041
Practice Address - Country:US
Practice Address - Phone:843-249-7736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist