Provider Demographics
NPI:1376903179
Name:GEORGE XENAKIS, DDS, PC
Entity Type:Organization
Organization Name:GEORGE XENAKIS, DDS, PC
Other - Org Name:U DREAM DENTAL - NORTHRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:XENAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-374-5082
Mailing Address - Street 1:10149 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-1454
Mailing Address - Country:US
Mailing Address - Phone:818-882-3710
Mailing Address - Fax:818-882-3395
Practice Address - Street 1:10149 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-1454
Practice Address - Country:US
Practice Address - Phone:818-882-3710
Practice Address - Fax:818-882-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64232261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental