Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 19885 | CA |
NPI | 1033235023 |
---|---|
Provider Name | Dr. Jack George |
First Address | Rancho Santa Margarita, CA 92688-1836 |
Second Address | Rancho Santa Margarita, CA 92688-1836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 11/09/2013 |