Provider Demographics
NPI:1457536922
Name:MAITRE, GEORGE MICHAEL JR
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:MAITRE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:G.
Other - Middle Name:MICHAEL
Other - Last Name:MAITRE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 UNIVERSITY BLVD S # A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2923
Mailing Address - Country:US
Mailing Address - Phone:251-344-4571
Mailing Address - Fax:251-344-2413
Practice Address - Street 1:801 UNIVERSITY BLVD S # A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2923
Practice Address - Country:US
Practice Address - Phone:251-344-4571
Practice Address - Fax:251-344-2413
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-92383OtherBLUE CROSS BLUE SHIELD AL
677496OtherUNITED CONCORDIA