Provider Demographics
NPI:1710592522
Name:TALMAZOV, GEORGI
Entity type:Individual
Prefix:
First Name:GEORGI
Middle Name:
Last Name:TALMAZOV
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GEORGI
Other - Middle Name:
Other - Last Name:TALMAZOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:218 BAY ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2783
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:218 BAY ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2783
Practice Address - Country:US
Practice Address - Phone:410-820-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36537122300000X
VA0401416687122300000X
DCDEN20001791223P0700X
MD183151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist