Provider Demographics
NPI:1508916685
Name:POIRIER, GEORGE THOMAS JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:THOMAS
Last Name:POIRIER
Suffix:JR
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 1:2806 DENTON RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2110
Mailing Address - Country:US
Mailing Address - Phone:734-495-9181
Mailing Address - Fax:
Practice Address - Street 1:132 S INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9493
Practice Address - Country:US
Practice Address - Phone:734-944-7400
Practice Address - Fax:734-944-2669
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice