Provider Demographics
NPI:1255676193
Name:ST. GEORGES, BARBARA (RDH)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:ST. GEORGES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BROOKDALE RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3309
Mailing Address - Country:US
Mailing Address - Phone:857-453-0547
Mailing Address - Fax:
Practice Address - Street 1:13 BROOKDALE RD
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3309
Practice Address - Country:US
Practice Address - Phone:857-453-0547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13305124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist