MEDICARE: STEVEN GEORGE

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	DEN.00203628	CO

General Provider Information

NPI Number	:	1750875019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN GEORGE

Provider Business Mailing Address
First Line	:	5925 LEHMAN DR STE 2
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3418
Country	:	US
Telephone Number	:	719-598-6966
Fax Number	:

Provider Business Practice Location Address
First Line	:	5925 LEHMAN DR STE 2
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3418
Country	:	US
Telephone Number	:	719-598-6966
Fax Number	:

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

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	06/20/2018

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