Healthcare Provider Details

I. General information

NPI: 1689774895
Provider Name (Legal Business Name): KAROLYN KAY GEORGE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARY KAY GEORGE DDS

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10566 N HIGHWAY 191
ELFRIDA AZ
85610-9021
US

IV. Provider business mailing address

155 CALLE PORTAL SUITE 100
SIERRA VISTA AZ
85635-2900
US

V. Phone/Fax

Practice location:
  • Phone: 520-642-2222
  • Fax: 520-642-3591
Mailing address:
  • Phone: 520-459-3012
  • Fax: 520-559-8663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberWY1050
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD07772
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: