Provider Demographics
NPI:1356554224
Name:PUGH, GEORGE SPENCER (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:SPENCER
Last Name:PUGH
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 1:7784 BALLSTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153
Mailing Address - Country:US
Mailing Address - Phone:703-455-3960
Mailing Address - Fax:
Practice Address - Street 1:8492 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309
Practice Address - Country:US
Practice Address - Phone:703-780-3300
Practice Address - Fax:703-780-3300
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401003880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist