Organization
MARK A. GEORGE D.D.S., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANA LESLIE COSTELLO (OFFICE ADMINISTRATOR)
(714) 953-1000
Entity
Organization
Contact information
Practice address
1140 W LA VETA AVE STE 530, ORANGE, CA 92868-4227
(714) 953-1000
(714) 953-9957
Mailing address
1140 W LA VETA AVE STE 530, ORANGE, CA 92868-4227
(714) 953-1000
(714) 953-9957
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
31142
CA
Other
Enumeration date
09/01/2010
Last updated
09/01/2010
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