Provider Demographics
NPI:1104294826
Name:GEORGE, IRENE M
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1001 PACIFIC ST STE E
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4455
Mailing Address - Country:US
Mailing Address - Phone:831-747-1794
Mailing Address - Fax:831-920-1471
Practice Address - Street 1:1001 PACIFIC ST STE E
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-747-1794
Practice Address - Fax:831-920-1471
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA64809OtherDENTAL LICNSE