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General NPI Number Information
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NPI Number | 1487725529
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Entity Type | Organization
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Legal Business Name | GEORGE MEDNICK, DDS, A PROFESSIONALL CORPORATION
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Dates
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Enumeration Date | 11/12/2006
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Last Update Date | 03/01/2014
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Provider Practice Location Address
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Address Line | 13264 GLEN BRAE DR
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City | SARATOGA
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State | CA
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Zip | 95070-4425
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Country | US
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Telephone | 408-867-5546
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Fax |
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Provider Business Mailing Address
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Address Line | 13264 GLEN BRAE DR
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City | SARATOGA
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State | CA
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Zip | 95070-4425
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Country | US
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Telephone | 408-867-5546
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE ANTHONY MEDNICK
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Credential | DDS
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Telephone | 408-867-5546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D22165
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License Number State | CA
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