Provider Demographics
NPI:1497241244
Name:MICHOS, GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:MICHOS
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 1:4820 OLD MAIN ST
Mailing Address - Street 2:SKYLINE, APT 401
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231
Mailing Address - Country:US
Mailing Address - Phone:804-441-0754
Mailing Address - Fax:
Practice Address - Street 1:3120 KILN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-5648
Practice Address - Country:US
Practice Address - Phone:757-877-9281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014161431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice