Provider Demographics
NPI:1972757813
Name:ST. GEORGE, NICHOLAS SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:SCOTT
Last Name:ST. GEORGE
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 1:10249 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2362
Mailing Address - Country:US
Mailing Address - Phone:562-927-2602
Mailing Address - Fax:
Practice Address - Street 1:10249 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2362
Practice Address - Country:US
Practice Address - Phone:562-927-2602
Practice Address - Fax:562-928-9232
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA576141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice