Provider Demographics
NPI:1518004068
Name:DORRIS, GEORGE B JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:B
Last Name:DORRIS
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 1:1115 EGLIN PKWY
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1228
Mailing Address - Country:US
Mailing Address - Phone:850-651-1125
Mailing Address - Fax:850-651-5887
Practice Address - Street 1:1115 EGLIN PKWY
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1228
Practice Address - Country:US
Practice Address - Phone:850-651-1125
Practice Address - Fax:850-651-5887
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice