Healthcare Provider Details

I. General information

NPI: 1154338960
Provider Name (Legal Business Name): SCOTT C. GEORGE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2533 STATE HIGHWAY 22 W
DARDANELLE AR
72834-8831
US

IV. Provider business mailing address

PO BOX 447
DARDANELLE AR
72834-0447
US

V. Phone/Fax

Practice location:
  • Phone: 479-229-3891
  • Fax: 479-229-2264
Mailing address:
  • Phone: 479-229-3891
  • Fax: 479-229-2264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3233
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3233
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: