Provider Demographics
NPI:1386215259
Name:GEORGE, ALYSA ROSE (DMD)
Entity Type:Individual
Prefix:
First Name:ALYSA
Middle Name:ROSE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10107 E 42ND CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-9667
Mailing Address - Country:US
Mailing Address - Phone:509-590-3586
Mailing Address - Fax:
Practice Address - Street 1:2121 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2207
Practice Address - Country:US
Practice Address - Phone:509-590-3586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61172991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist