Provider Demographics
NPI:1568891000
Name:MADDOX, GEORGE WESTON II (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WESTON
Last Name:MADDOX
Suffix:II
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 1:320 SUPERIOR AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2740
Mailing Address - Country:US
Mailing Address - Phone:949-548-5029
Mailing Address - Fax:949-548-0373
Practice Address - Street 1:320 SUPERIOR AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2740
Practice Address - Country:US
Practice Address - Phone:949-548-5029
Practice Address - Fax:949-548-0373
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist