Provider Demographics
NPI:1295117729
Name:GEORGE, GERRY JACOB (DMD)
Entity type:Individual
Prefix:DR
First Name:GERRY
Middle Name:JACOB
Last Name:GEORGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-2666
Mailing Address - Country:US
Mailing Address - Phone:864-882-2424
Mailing Address - Fax:864-882-2476
Practice Address - Street 1:16 COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2666
Practice Address - Country:US
Practice Address - Phone:864-882-2424
Practice Address - Fax:864-882-2476
Is Sole Proprietor?:No
Enumeration Date:2015-06-20
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice