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General NPI Number Information
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NPI Number | 1801866793
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Entity Type | Individual
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Provider Name | KEITRA TUNISHA GEORGE DDS
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Gender | Female
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 576 JEFFERSON AVE
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City | FORT EUSTIS
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State | VA
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Zip | 23604-1373
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Country | US
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Telephone | 757-314-7925
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Fax | 757-314-7926
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Provider Business Mailing Address
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Address Line | 576 JEFFERSON AVE
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City | FORT EUSTIS
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State | VA
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Zip | 23604-1373
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Country | US
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Telephone | 757-314-7925
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS036217
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DS036217
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License Number State | PA
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