Healthcare Provider Details

I. General information

NPI: 1922269141
Provider Name (Legal Business Name): SHEEBA GEORGE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510FM 1960 ROAD WEST
HOUSTON TX
77069
US

IV. Provider business mailing address

1218 SW MILITARY DR
SAN ANTONIO TX
78221-1535
US

V. Phone/Fax

Practice location:
  • Phone: 201-344-8779
  • Fax:
Mailing address:
  • Phone: 210-928-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25075
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22193
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: