Provider Demographics
NPI:1750495396
Name:PODRAY, GEORGE ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ANDREW
Last Name:PODRAY
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:3469 W BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4611
Mailing Address - Country:US
Mailing Address - Phone:561-736-8755
Mailing Address - Fax:561-736-3996
Practice Address - Street 1:3469 W BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 20
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4611
Practice Address - Country:US
Practice Address - Phone:561-736-8755
Practice Address - Fax:561-736-3996
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN 00118641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics