Basic Information
| Provider Information | |||||||||
| NPI: | 1689774895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | KAROLYN | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GEORGE | ||||||||
| OtherFirstName: | KARY | ||||||||
| OtherMiddleName: | KAY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DDS | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 155 CALLE PORTAL | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856352900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204593012 | ||||||||
| FaxNumber: | 5205598663 | ||||||||
| Practice Location | |||||||||
| Address1: | 10566 N HIGHWAY 191 | ||||||||
| Address2: | |||||||||
| City: | ELFRIDA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856109021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206422222 | ||||||||
| FaxNumber: | 5206423591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 10/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | WY1050 | WY | N | Dental Providers | Dentist | General Practice | 1223G0001X | D07772 | AZ | Y | Dental Providers | Dentist | General Practice |
No ID Information.