Healthcare Provider Details

I. General information

NPI: 1487612347
Provider Name (Legal Business Name): GEORGE J VASILAKIS DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 09/27/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 467 BOX 3785
APO AE
09096
US

IV. Provider business mailing address

CMR 467 BOX 3785
APO AE
09096
US

V. Phone/Fax

Practice location:
  • Phone: 06117055804
  • Fax:
Mailing address:
  • Phone: 06117055804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13582
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: