Provider Demographics
NPI:1487855797
Name:MICHAELS, GEORGE GERSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GERSON
Last Name:MICHAELS
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 1:825 OAK GROVE AVE STE C501
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4427
Mailing Address - Country:US
Mailing Address - Phone:650-854-6063
Mailing Address - Fax:
Practice Address - Street 1:825 OAK GROVE AVE STE C501
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4427
Practice Address - Country:US
Practice Address - Phone:650-323-5211
Practice Address - Fax:650-323-0515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice