Healthcare Provider Details

I. General information

NPI: 1023121472
Provider Name (Legal Business Name): GEORGE MANUEL TZAGOURNIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 COUNTY LINE RD W STE 100
WESTERVILLE OH
43082-6062
US

IV. Provider business mailing address

385 COUNTY LINE RD W STE 100
WESTERVILLE OH
43082-6062
US

V. Phone/Fax

Practice location:
  • Phone: 614-882-4032
  • Fax: 614-882-7260
Mailing address:
  • Phone: 614-882-4032
  • Fax: 614-882-7260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30020556
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: