Provider Demographics
NPI:1487725529
Name:GEORGE MEDNICK, DDS, A PROFESSIONALL CORPORATION
Entity type:Organization
Organization Name:GEORGE MEDNICK, DDS, A PROFESSIONALL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MEDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-867-5546
Mailing Address - Street 1:13264 GLEN BRAE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4425
Mailing Address - Country:US
Mailing Address - Phone:408-867-5546
Mailing Address - Fax:
Practice Address - Street 1:13264 GLEN BRAE DR
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4425
Practice Address - Country:US
Practice Address - Phone:408-867-5546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD221651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty