Provider Demographics
NPI:1700099769
Name:PLOUMBIS, GEORGE CONSTANTINE
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CONSTANTINE
Last Name:PLOUMBIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6105
Mailing Address - Country:US
Mailing Address - Phone:330-372-6888
Mailing Address - Fax:
Practice Address - Street 1:2239 EAST MARKET STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6105
Practice Address - Country:US
Practice Address - Phone:330-372-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice