Provider Demographics
NPI:1538307814
Name:GEORGE, JOBY KOOVAKADA (DDS)
Entity type:Individual
Prefix:DR
First Name:JOBY
Middle Name:KOOVAKADA
Last Name:GEORGE
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 1:6600 ABERCORN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5800
Mailing Address - Country:US
Mailing Address - Phone:912-354-3880
Mailing Address - Fax:
Practice Address - Street 1:6600 ABERCORN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5800
Practice Address - Country:US
Practice Address - Phone:912-354-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0138271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics