Provider Demographics
NPI:1902405731
Name:MESSIAH, GEORGE SAMY (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:SAMY
Last Name:MESSIAH
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 1:1232 AMARYLLIS WAY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7327
Mailing Address - Country:US
Mailing Address - Phone:951-824-0699
Mailing Address - Fax:
Practice Address - Street 1:12571 LIMONITE AVE
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-3676
Practice Address - Country:US
Practice Address - Phone:951-360-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS105355122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist