Provider Demographics
NPI:1265648240
Name:GEORGE STALEY D.D.S. INC.
Entity Type:Organization
Organization Name:GEORGE STALEY D.D.S. INC.
Other - Org Name:ASSOCIATION FOR DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:STALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-921-8888
Mailing Address - Street 1:12808 DREXMORE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2158
Mailing Address - Country:US
Mailing Address - Phone:216-921-8888
Mailing Address - Fax:216-921-8889
Practice Address - Street 1:12808 DREXMORE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2158
Practice Address - Country:US
Practice Address - Phone:216-921-8888
Practice Address - Fax:216-921-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty