Provider Demographics
NPI:1780640144
Name:MARANON, GEORGE A (DDS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:A
Last Name:MARANON
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 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE 820
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-990-5500
Mailing Address - Fax:818-990-5520
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 820
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-990-5500
Practice Address - Fax:818-990-5520
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD321271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG43517Medicare UPIN