Provider Demographics
NPI:1386004182
Name:GEORGE XENAKIS, DDS, PC
Entity type:Organization
Organization Name:GEORGE XENAKIS, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:XENAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-374-5082
Mailing Address - Street 1:10130 GARDEN GROVE BLVD
Mailing Address - Street 2:#201
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1689
Mailing Address - Country:US
Mailing Address - Phone:714-636-0088
Mailing Address - Fax:714-636-0089
Practice Address - Street 1:10130 GARDEN GROVE BLVD
Practice Address - Street 2:#201
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1689
Practice Address - Country:US
Practice Address - Phone:714-636-0088
Practice Address - Fax:714-636-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64232261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental