Provider Demographics
NPI:1619462355
Name:TZOMIDES, GEORGE
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:TZOMIDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MIDDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-4114
Mailing Address - Country:US
Mailing Address - Phone:410-686-6510
Mailing Address - Fax:
Practice Address - Street 1:30 MIDDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-4114
Practice Address - Country:US
Practice Address - Phone:410-686-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD164561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice