Provider Demographics
NPI:1700136645
Name:GEORGE, STEPHEN W (DMD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:GEORGE
Suffix:
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 1:606 W MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5892
Mailing Address - Country:US
Mailing Address - Phone:352-787-4800
Mailing Address - Fax:
Practice Address - Street 1:606 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5892
Practice Address - Country:US
Practice Address - Phone:352-787-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX325441223G0001X
ORD97691223G0001X
FLDN238481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice