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General NPI Number Information
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NPI Number | 1790270080
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Entity Type | Organization
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Legal Business Name | GEORGE ORTHODONTICS PLLC
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 7770 N UNION BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920
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Country | US
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Telephone | 719-594-9797
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Fax | 719-594-6713
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Provider Business Mailing Address
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Address Line | 7770 N UNION BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-4087
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Country | US
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Telephone | 719-594-9797
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Fax | 719-594-6713
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Authorized Official
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Title or Position | OFFICE RECEPTIONIST
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Name | MRS. MARCELLE R KEYSER
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Credential |
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Telephone | 719-439-3228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9700
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License Number State | CO
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