Provider Demographics
NPI:1881870319
Name:GEORGIEV, GEORGI (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGI
Middle Name:
Last Name:GEORGIEV
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 1:511 SE 5TH AVE APT 2203
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2980
Mailing Address - Country:US
Mailing Address - Phone:305-942-6465
Mailing Address - Fax:
Practice Address - Street 1:2235 N COMMERCE PKWY
Practice Address - Street 2:STE 1
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3251
Practice Address - Country:US
Practice Address - Phone:954-389-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist