Provider Demographics
NPI:1063537082
Name:GEORGE, MATHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 MCDERMOTT RD
Mailing Address - Street 2:STE B
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025
Mailing Address - Country:US
Mailing Address - Phone:469-269-6190
Mailing Address - Fax:469-277-3149
Practice Address - Street 1:3920 MCDERMOTT RD
Practice Address - Street 2:STE B
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025
Practice Address - Country:US
Practice Address - Phone:469-269-6190
Practice Address - Fax:469-277-3149
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice