Provider Demographics
NPI:1265572226
Name:BIEDERMAN, GEORGE ROLAND JR (DDS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ROLAND
Last Name:BIEDERMAN
Suffix:JR
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 1:1400 BUFORD HWY
Mailing Address - Street 2:SUITE T- 1
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8721
Mailing Address - Country:US
Mailing Address - Phone:770-945-1080
Mailing Address - Fax:770-945-1090
Practice Address - Street 1:1400 BUFORD HWY
Practice Address - Street 2:SUITE T- 1
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-8721
Practice Address - Country:US
Practice Address - Phone:770-945-1080
Practice Address - Fax:770-945-1090
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10301OtherDENTAL LICENSE