Healthcare Provider Details

I. General information

NPI: 1568023331
Provider Name (Legal Business Name): DAVID A GEORGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 TAMPA RD STE 6
OLDSMAR FL
34677-3232
US

IV. Provider business mailing address

11224 CAVALIER PL
TAMPA FL
33626-2676
US

V. Phone/Fax

Practice location:
  • Phone: 813-448-7828
  • Fax:
Mailing address:
  • Phone: 856-397-5146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS042835
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN27609
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: