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General NPI Number Information
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NPI Number | 1679620926
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Entity Type | Individual
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Provider Name | GEORGE J. PAPASIKOS D.MD., F.A.G.D, P.A.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 55 PARK ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3439
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Country | US
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Telephone | 973-783-2300
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Fax | 973-783-8756
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Provider Business Mailing Address
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Address Line | 55 PARK ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3439
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Country | US
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Telephone | 973-783-2300
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Fax | 973-783-8756
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 11721
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License Number State | NJ
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