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General NPI Number Information
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NPI Number | 1225372857
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Entity Type | Individual
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Provider Name | DR. SUSAN THOMAS GEORGE
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Gender | Female
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 1013 LOCKWOOD BLVD UNIT#7
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City | OVIEDO
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State | FL
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Zip | 32765-6001
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Country | US
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Telephone | 407-278-0934
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Fax |
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Provider Business Mailing Address
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Address Line | 1940 GARDEN SAGE DR
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City | OVIEDO
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State | FL
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Zip | 32765-4619
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Country | US
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Telephone | 478-290-3850
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 20004
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License Number State | FL
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