Provider Demographics
NPI:1023121472
Name:TZAGOURNIS, GEORGE MANUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MANUEL
Last Name:TZAGOURNIS
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 1:385 COUNTY LINE RD W
Mailing Address - Street 2:STE 100
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6062
Mailing Address - Country:US
Mailing Address - Phone:614-882-4032
Mailing Address - Fax:614-882-7260
Practice Address - Street 1:385 COUNTY LINE RD W
Practice Address - Street 2:STE 100
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6062
Practice Address - Country:US
Practice Address - Phone:614-882-4032
Practice Address - Fax:614-882-7260
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300205561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice