Provider Demographics
NPI:1306404959
Name:GEORGE, ALAN
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E HOSPITAL RD
Mailing Address - Street 2:US ARMY DENTAC
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905
Mailing Address - Country:US
Mailing Address - Phone:614-266-4307
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAC
Practice Address - Street 2:9900 LINCOLN STREET, 2ND FLOOR
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98327
Practice Address - Country:US
Practice Address - Phone:253-698-4079
Practice Address - Fax:253-968-5919
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist