=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285831891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAN F. JUSTIN & CALEB A. GEORGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 73 TROY RD SUITE 2G
-----------------------------------------------------
City | EAST GREENBUSH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12061-1334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-477-5360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73 TROY RD SUITE 2G
-----------------------------------------------------
City | EAST GREENBUSH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12061-1334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-477-5360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | CALEB A. GEORGE
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 518-477-5360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 34479
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------