Provider Demographics
NPI:1255697082
Name:ERIC GEORGE, DMD LTD.
Entity type:Organization
Organization Name:ERIC GEORGE, DMD LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILLMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-822-3352
Mailing Address - Street 1:121 SANDY BOTTOM ROAD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816
Mailing Address - Country:US
Mailing Address - Phone:401-822-3352
Mailing Address - Fax:401-822-3353
Practice Address - Street 1:121 SANDY BOTTOM ROAD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816
Practice Address - Country:US
Practice Address - Phone:401-822-3352
Practice Address - Fax:401-822-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2988122300000X
RI3081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty