Provider Demographics
NPI:1790758555
Name:GEORGE, MARK D (DDS, MS, PC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:GEORGE
Suffix:
Gender:M
Credentials:DDS, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7770 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4086
Mailing Address - Country:US
Mailing Address - Phone:719-594-9797
Mailing Address - Fax:308-594-6713
Practice Address - Street 1:7770 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4087
Practice Address - Country:US
Practice Address - Phone:719-594-9797
Practice Address - Fax:308-594-6713
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics