Provider Demographics
NPI:1205267317
Name:GEORGE, KENNETH JR (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:GEORGE
Suffix:JR
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 1:1447 ZION HILL RD
Mailing Address - Street 2:
Mailing Address - City:FINCASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24090-4017
Mailing Address - Country:US
Mailing Address - Phone:540-884-2404
Mailing Address - Fax:
Practice Address - Street 1:1447 ZION HILL RD
Practice Address - Street 2:
Practice Address - City:FINCASTLE
Practice Address - State:VA
Practice Address - Zip Code:24090-4017
Practice Address - Country:US
Practice Address - Phone:540-884-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-29
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist