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General NPI Number Information
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NPI Number | 1497241244
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Entity Type | Individual
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Provider Name | GEORGE MICHOS DDS
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Gender | Male
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 3120 KILN CREEK PKWY
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City | YORKTOWN
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State | VA
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Zip | 23693-5648
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Country | US
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Telephone | 757-877-9281
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Fax |
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Provider Business Mailing Address
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Address Line | 4820 OLD MAIN ST SKYLINE, APT 401
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City | HENRICO
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State | VA
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Zip | 23231
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Country | US
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Telephone | 804-441-0754
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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 | 0401416143
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License Number State | VA
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