# KING GEORGE DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538412424
- **Authorized official:** DR. PHILIP JAMES SPORY DDS (PRESIDENT)
- **Authorized official phone:** (540) 663-3139

## Contact information

- **Practice address:** 15521 REAL ESTATE AVE, STE 200, KING GEORGE, VA 22485-5327
- **Practice address phone:** (540) 663-3139
- **Mailing address:** 15521 REAL ESTATE AVE, STE 200, KING GEORGE, VA 22485-5327
- **Mailing address phone:** (540) 663-3139

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401413422 | VA | Yes |

## Other

- **Enumeration date:** 10/17/2012
- **Last updated:** 12/06/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5057872 | — | WA |