Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 34479 | NY |
NPI | 1043437643 |
---|---|
Provider Name | Dr. Caleb A. George |
First Address | Burnt Hills, NY 12027-9405 |
Second Address | Burnt Hills, NY 12027-9405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |