Provider Demographics
NPI:1518373836
Name:GEORGE, ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:GEORGE
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 1:7770 N UNION BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4086
Mailing Address - Country:US
Mailing Address - Phone:719-424-8372
Mailing Address - Fax:
Practice Address - Street 1:7770 N UNION BLVD STE B
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4086
Practice Address - Country:US
Practice Address - Phone:719-424-8372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62231740Medicaid