George Lee Trask, DDS
Individual provider
Active NPI
Dentist · Monroeville, OH
NPI 1114933801 · NPPES record last updated Oct 9, 2013
Key facts
- NPI
- 1114933801
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 30018914 (OH)
- Practice address
- 136 North Ridge St
Ste C
Monroeville, OH 44847-9428
- Phone
- (419) 465-2574
- Fax
- (419) 465-2598
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20151211001618 |
OH |
Order and Referring Only - Other (Physician)
Practitioner - Other (Physician) |
0648571836 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| 30018914 | OH | MD | Dentist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Dentist |
122300000X |
30018914 |
OH |
Yes |
Addresses
Primary practice location
136 North Ridge St
Ste C
Monroeville, OH 44847-9428
Mailing address
136 North Ridge St
Ste C
Monroeville, OH 44847-9428
Phone (419) 465-2574
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 2678526 | Medicaid | OH | |