Provider Demographics
NPI:1205991825
Name:KABOT, GEORGE MICHAEL (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:KABOT
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:DR
Other - First Name:G.
Other - Middle Name:MICHAEL
Other - Last Name:KABOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,MS
Mailing Address - Street 1:655 WEST 14 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1901
Mailing Address - Country:US
Mailing Address - Phone:248-280-2944
Mailing Address - Fax:248-280-0822
Practice Address - Street 1:655 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1918
Practice Address - Country:US
Practice Address - Phone:248-280-2944
Practice Address - Fax:248-280-0822
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI140971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics