Provider Demographics
NPI:1407966179
Name:PRIGAN, GEORGE (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:PRIGAN
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 1:8805 GOVERNORS HILL DR
Mailing Address - Street 2:STE 105
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-3314
Mailing Address - Country:US
Mailing Address - Phone:513-385-7750
Mailing Address - Fax:513-697-2650
Practice Address - Street 1:9505 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251
Practice Address - Country:US
Practice Address - Phone:513-385-7750
Practice Address - Fax:513-697-2650
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH120891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0034046Medicaid