Healthcare Provider Details

I. General information

NPI: 1700311982
Provider Name (Legal Business Name): MARILYN ESTHAPPAN GEORGE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24828 JERICHO TPKE
FLORAL PARK NY
11001
US

IV. Provider business mailing address

24510 GRAND CENTRAL PKWY APT LA-10
BELLEROSE NY
11426-2744
US

V. Phone/Fax

Practice location:
  • Phone: 516-519-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number059907
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: