Provider Demographics
NPI:1578136537
Name:MICHAEL, GEORGE DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DAVID
Last Name:MICHAEL
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 1:12601 N GRANVILLE CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-8936
Mailing Address - Country:US
Mailing Address - Phone:847-280-0471
Mailing Address - Fax:
Practice Address - Street 1:12601 N GRANVILLE CANYON WAY
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-8936
Practice Address - Country:US
Practice Address - Phone:847-280-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist