Healthcare Provider Details

I. General information

NPI: 1962514828
Provider Name (Legal Business Name): IONEL GEORGESCU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11328 BARTLETT AVE STE 3
ADELANTO CA
92301-1913
US

IV. Provider business mailing address

11328 BARTLETT AVE STE 3
ADELANTO CA
92301-1913
US

V. Phone/Fax

Practice location:
  • Phone: 760-237-8848
  • Fax: 760-237-8847
Mailing address:
  • Phone: 760-237-8848
  • Fax: 760-237-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: