Provider Demographics
NPI:1174623094
Name:ELIADES, GEORGE N (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:N
Last Name:ELIADES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15541 BEACH BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7114
Mailing Address - Country:US
Mailing Address - Phone:714-253-3204
Mailing Address - Fax:714-657-3704
Practice Address - Street 1:15541 BEACH BLVD STE D
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7114
Practice Address - Country:US
Practice Address - Phone:714-253-3204
Practice Address - Fax:714-657-3704
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist