Provider Demographics
NPI:1841851029
Name:STAMATIADES, GEORGE PERICLES III (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PERICLES
Last Name:STAMATIADES
Suffix:III
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 1:2830 HIGHWAY 52
Mailing Address - Street 2:STE 360
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461
Mailing Address - Country:US
Mailing Address - Phone:843-990-4715
Mailing Address - Fax:
Practice Address - Street 1:2830 HIGHWAY 52
Practice Address - Street 2:STE 360
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461
Practice Address - Country:US
Practice Address - Phone:843-990-4715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.98981223G0001X
WADE611940371223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program