Healthcare Provider Details

I. General information

NPI: 1518093442
Provider Name (Legal Business Name): GEORGE MICHAEL GEORGELIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 OREGON PIKE
LANCASTER PA
17601-4604
US

IV. Provider business mailing address

2175 OREGON PIKE
LANCASTER PA
17601-4604
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-7090
  • Fax: 717-569-0233
Mailing address:
  • Phone: 717-569-7090
  • Fax: 717-569-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS030595L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: