Provider Demographics
NPI:1619011004
Name:GEORGE, DANIEL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
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 1:275 W LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1903
Mailing Address - Country:US
Mailing Address - Phone:616-392-3169
Mailing Address - Fax:616-392-5529
Practice Address - Street 1:275 W LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1903
Practice Address - Country:US
Practice Address - Phone:616-392-3169
Practice Address - Fax:616-392-5529
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI097451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics