Provider Demographics
NPI:1477006492
Name:DEGEORGE DENTAL LLC
Entity Type:Organization
Organization Name:DEGEORGE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-735-7888
Mailing Address - Street 1:53 PAYNE RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833
Mailing Address - Country:US
Mailing Address - Phone:908-735-7888
Mailing Address - Fax:908-735-7976
Practice Address - Street 1:53 PAYNE RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833
Practice Address - Country:US
Practice Address - Phone:908-735-7888
Practice Address - Fax:908-735-7976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty