Provider Demographics
NPI:1598917031
Name:STALEY, GEORGE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:STALEY
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 1:12808 DREXMORE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2158
Mailing Address - Country:US
Mailing Address - Phone:216-921-8888
Mailing Address - Fax:216-921-8889
Practice Address - Street 1:12808 DREXMORE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2158
Practice Address - Country:US
Practice Address - Phone:216-921-8888
Practice Address - Fax:216-921-8889
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist