Provider Demographics
NPI:1487672523
Name:PURYEAR, GEORGE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:PURYEAR
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 1:101 MOORES LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-3207
Mailing Address - Country:US
Mailing Address - Phone:704-694-5707
Mailing Address - Fax:704-694-3826
Practice Address - Street 1:101 MOORES LAKE RD
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-3207
Practice Address - Country:US
Practice Address - Phone:704-694-5707
Practice Address - Fax:704-694-3826
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC97203OtherBC/BS PROVIDER #
NC97203Medicaid
NC97203Medicaid
NCAP5417325OtherDEA