Provider Demographics
NPI:1174746564
Name:DUELLO, GEORGE V (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:V
Last Name:DUELLO
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:V
Other - Last Name:DUELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS,PC
Mailing Address - Street 1:309 GREENBRIAR ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3350
Mailing Address - Country:US
Mailing Address - Phone:314-822-0765
Mailing Address - Fax:
Practice Address - Street 1:3555 SUNSET OFFICE DR
Practice Address - Street 2:SUITE C105
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1015
Practice Address - Country:US
Practice Address - Phone:314-965-3271
Practice Address - Fax:314-965-8113
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005981223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics