Provider Demographics
NPI:1487850681
Name:KERKORIAN, GEORGE JASPER (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JASPER
Last Name:KERKORIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:JASPER
Other - Last Name:KERKORIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10 CAITLIN CIR
Mailing Address - Street 2:
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-1869
Mailing Address - Country:US
Mailing Address - Phone:508-420-2488
Mailing Address - Fax:
Practice Address - Street 1:210 JONES RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2974
Practice Address - Country:US
Practice Address - Phone:508-540-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8658122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist