MEDICARE: GEORGE C. GEORGAKLIS DDS APC

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	1223G0001X	General Practice Dentistry	29051	CA

General Provider Information

NPI Number	:	1235295965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE C. GEORGAKLIS DDS APC

Provider Business Mailing Address
First Line	:	4510 EXECUTIVE DR STE 106
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3022
Country	:	US
Telephone Number	:	858-552-1223
Fax Number	:

Provider Business Practice Location Address
First Line	:	4510 EXECUTIVE DR STE 106
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3022
Country	:	US
Telephone Number	:	858-552-1223
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE C GEORGAKLIS
Credential	:	DDS
Telephone Number	:	858-552-1223

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/22/2020

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