MEDICARE: DR. BENOY KANNIKATTEL GEORGE BDS, DDS

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	10839	CT
2	1223P0700X	Prosthodontics	10456	MA
3	1223G0001X	General Practice Dentistry	9936	NC

General Provider Information

NPI Number	:	1528210853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENOY KANNIKATTEL GEORGE BDS, DDS

Provider Business Mailing Address
First Line	:	8334 PINEVILLE MATTHEWS RD UNIT 103-198
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3774
Country	:	US
Telephone Number	:	631-487-5895
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 FREEMAN DRIVE C 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273
Country	:	US
Telephone Number	:	980-580-4271
Fax Number	:

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

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	12/17/2025

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