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General NPI Number Information
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NPI Number | 1124013024
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Entity Type | Individual
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Provider Name | GEORGE BRADFORD DEESE DMD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 7051 DR PHILLIPS BLVD STE 9
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City | ORLANDO
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State | FL
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Zip | 32819-5140
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Country | US
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Telephone | 407-363-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 9242 BAY POINT DR
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City | ORLANDO
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State | FL
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Zip | 32819-4806
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Country | US
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Telephone | 352-682-5493
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN16697
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License Number State | FL
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