Provider Demographics
NPI:1902341233
Name:GEORGE C. PLOUMBIS, DDS, INC.
Entity type:Organization
Organization Name:GEORGE C. PLOUMBIS, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-372-6888
Mailing Address - Street 1:2239 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6105
Mailing Address - Country:US
Mailing Address - Phone:330-372-6888
Mailing Address - Fax:330-372-5197
Practice Address - Street 1:2239 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6105
Practice Address - Country:US
Practice Address - Phone:330-372-6888
Practice Address - Fax:330-372-5197
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE C. PLOUMBIS, DDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0238911223G0001X
OH0188331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty