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General NPI Number Information
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NPI Number | 1154982015
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Entity Type | Individual
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Provider Name | MARIA DESPINA GEORGAKIS DMD
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Gender | Female
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Dates
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Enumeration Date | 06/21/2019
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Last Update Date | 06/21/2019
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Provider Practice Location Address
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Address Line | 5607 SLIDE RD STE 200
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City | LUBBOCK
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State | TX
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Zip | 79414-4104
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Country | US
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Telephone | 806-792-1750
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 CHICAGO AVE APT 4310
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City | LUBBOCK
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State | TX
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Zip | 79414-6011
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Country | US
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Telephone | 909-579-9701
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 35291
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License Number State | TX
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