Provider Demographics
NPI:1811404205
Name:IRENE M. GEORGE, DDS, INC
Entity Type:Organization
Organization Name:IRENE M. GEORGE, DDS, INC
Other - Org Name:DR. IRENE GEORGE DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-747-1794
Mailing Address - Street 1:1001 PACIFIC ST STE E
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4455
Mailing Address - Country:US
Mailing Address - Phone:831-747-1794
Mailing Address - Fax:
Practice Address - Street 1:1001 PACIFIC ST STE E
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4455
Practice Address - Country:US
Practice Address - Phone:831-747-1793
Practice Address - Fax:831-235-5157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IRENE M. GEORGE, DDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-07
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty