Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 1562 | NH |
NPI | 1093921546 |
---|---|
Provider Name | Dr. Andrew Charles George |
First Address | Bedford, NH 03110-6765 |
Second Address | Bedford, NH 03110-6765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/07/2007 |