MEDICARE: ROBERT LAWRENCE GEORGE DMD

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
1	122300000X	Dentist	DN007721	GA

General Provider Information

NPI Number	:	1124121165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT LAWRENCE GEORGE DMD

Provider Business Mailing Address
First Line	:	1520-A JENNINGS MILL ROAD
Second Line	:
City	:	BOGART
State	:	GA
Zip	:	30622-2543
Country	:	US
Telephone Number	:	706-353-1958
Fax Number	:	706-353-3939

Provider Business Practice Location Address
First Line	:	1520-A JENNINGS MILL ROAD
Second Line	:
City	:	BOGART
State	:	GA
Zip	:	30622-2543
Country	:	US
Telephone Number	:	706-353-1958
Fax Number	:	706-353-3939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	02/10/2010

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