Provider Demographics
NPI:1326192378
Name:GEORGE, TITUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:TITUS
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2997
Mailing Address - Country:US
Mailing Address - Phone:908-304-0774
Mailing Address - Fax:
Practice Address - Street 1:37 MOUNTAIN BLVD STE 4
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2622
Practice Address - Country:US
Practice Address - Phone:908-546-7444
Practice Address - Fax:908-546-7445
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506181223G0001X
NJ22DI02401700122300000X
PADS038923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0189740Medicaid
NY02638719Medicaid
PA102654285Medicaid