Provider Demographics
NPI:1679718332
Name:BANDELAC, GEORGES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGES
Middle Name:
Last Name:BANDELAC
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 1:3855 W CHESTER PIKE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2304
Mailing Address - Country:US
Mailing Address - Phone:484-420-4643
Mailing Address - Fax:484-420-4645
Practice Address - Street 1:3855 W CHESTER PIKE
Practice Address - Street 2:SUITE 225
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2304
Practice Address - Country:US
Practice Address - Phone:484-420-4643
Practice Address - Fax:484-420-4645
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0381701223P0300X
MI29010197231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics