MEDICARE: DR. GEORGE A. M. SONBOL D.D.S.

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	0401411922	VA
2	1223G0001X	General Practice Dentistry	DN19532	FL
3	1223G0001X	General Practice Dentistry	DE00011239	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427258631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE A. M. SONBOL D.D.S.

Provider Business Mailing Address
First Line	:	706 BRIGHTVIEW DR
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2336
Country	:	US
Telephone Number	:	504-919-1987
Fax Number	:

Provider Business Practice Location Address
First Line	:	4003 S NOVA RD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4922
Country	:	US
Telephone Number	:	386-763-2000
Fax Number	:	386-763-2080

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

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	12/15/2011

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