Provider Demographics
NPI:1407071533
Name:DIMITRI, GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:DIMITRI
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 1:149 SMALLWOOD VILLAGE CTR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1851
Mailing Address - Country:US
Mailing Address - Phone:301-843-1333
Mailing Address - Fax:301-645-7405
Practice Address - Street 1:149 SMALLWOOD VILLAGE CTR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1851
Practice Address - Country:US
Practice Address - Phone:301-843-1333
Practice Address - Fax:301-645-7405
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12571122300000X
PADS031614L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist