Provider Demographics
NPI:1376872747
Name:POPOWYCH, GEORGE BASIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BASIL
Last Name:POPOWYCH
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 1:1708 E CHURCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-4806
Mailing Address - Country:US
Mailing Address - Phone:410-879-7726
Mailing Address - Fax:
Practice Address - Street 1:1708 E CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-4806
Practice Address - Country:US
Practice Address - Phone:410-879-7726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD087341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice