Provider Demographics
NPI:1720044597
Name:FLITCRAFT, GEORGE D (DMD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:D
Last Name:FLITCRAFT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 HIWAY 95
Mailing Address - Street 2:STE 33
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7860
Mailing Address - Country:US
Mailing Address - Phone:928-763-8750
Mailing Address - Fax:928-763-8801
Practice Address - Street 1:3003 HIWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7896
Practice Address - Country:US
Practice Address - Phone:928-763-8750
Practice Address - Fax:928-763-8801
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice