Provider Demographics
NPI:1619014172
Name:GEORGE GEORGIEFF, DDS, INC.
Entity type:Organization
Organization Name:GEORGE GEORGIEFF, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGIEFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-545-0437
Mailing Address - Street 1:620 W EDINGER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-1602
Mailing Address - Country:US
Mailing Address - Phone:714-545-0437
Mailing Address - Fax:714-751-3922
Practice Address - Street 1:620 W EDINGER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-1602
Practice Address - Country:US
Practice Address - Phone:714-545-0437
Practice Address - Fax:714-751-3922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD16525261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental