Provider Demographics
NPI:1487207239
Name:GEORGIEV, GEORGE DUNCAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:DUNCAN
Last Name:GEORGIEV
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 1:12 HOLBROOK CRESCENT
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N1T 1V7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 HOLBROOK CRESCENT
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:ONTARIO
Practice Address - Zip Code:N1T 1V7
Practice Address - Country:CA
Practice Address - Phone:917-617-0162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016002261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice