Provider Demographics
NPI:1124121165
Name:GEORGE, ROBERT LAWRENCE (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:GEORGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520-A JENNINGS MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2543
Mailing Address - Country:US
Mailing Address - Phone:706-353-1958
Mailing Address - Fax:706-353-3939
Practice Address - Street 1:1520-A JENNINGS MILL ROAD
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2543
Practice Address - Country:US
Practice Address - Phone:706-353-1958
Practice Address - Fax:706-353-3939
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN007721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist