Provider Demographics
NPI:1992744890
Name:WAITES, GEORGE B (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:B
Last Name:WAITES
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 1:2124 CECIL ASHBURN DR
Mailing Address - Street 2:SUITE130
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-8619
Mailing Address - Country:US
Mailing Address - Phone:256-880-7992
Mailing Address - Fax:
Practice Address - Street 1:8 BATTERY ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-5234
Practice Address - Country:US
Practice Address - Phone:256-880-7992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice