=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124106687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL L. GEORGE DDS, MSD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 11/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 AVENUE D. SUITE 101
-----------------------------------------------------
City | SNOHOMISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-568-1519
-----------------------------------------------------
Fax | 360-568-8935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 AVENUE D. SUITE 101
-----------------------------------------------------
City | SNOHOMISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-568-1519
-----------------------------------------------------
Fax | 360-568-8935
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL L GEORGE
-----------------------------------------------------
Credential | DDS, MSD
-----------------------------------------------------
Telephone | 360-568-1519
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DE00010038
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------