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NPI Code Detail

MEDICARE: GEORGE & DEST, DDS, PLLC

MEDICARE: GEORGE & DEST, DDS, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1104303668
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGE & DEST, DDS, PLLC
Provider Business Mailing Address
First Line : 201 MCCULLOUGH DR STE 180
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-1302
Country : US
Telephone Number : 704-790-4402
Fax Number :
Provider Business Practice Location Address
First Line : 107 E MOUNTAIN ST
Second Line :
City : KINGS MOUNTAIN
State : NC
Zip : 28086-3442
Country : US
Telephone Number : 704-739-4473
Fax Number :
Authorized Official
Title or Position : MEMBER/ORGANIZER
Name : RONNIE GEORGE
Credential : DDS
Telephone Number : 704-739-4473
Provider Enumeration Date : 07/26/2018
Last Update Date : 07/26/2018

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Directions to “GEORGE & DEST, DDS, PLLC ” Practice Location

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