George Wallace Tate, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

LA2383 Issued in LA

Practice address

Rocky Boy Health Board
RR 1 Box 664
Box Elder, MT 59521-9797

Phone

(406) 395-4486

Fax

(406) 395-5850

NPI assigned

Jul 3, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190160000000",
    "number": "1649478587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RR 1 BOX 664",
            "address_2": "ROCKY BOY HEALTH BOARD",
            "city": "BOX ELDER",
            "state": "MT",
            "postal_code": "595219797",
            "telephone_number": "406-395-4486",
            "fax_number": "406-395-5850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ROCKY BOY HEALTH BOARD",
            "address_2": "RR 1 BOX 664",
            "city": "BOX ELDER",
            "state": "MT",
            "postal_code": "595219797",
            "telephone_number": "406-395-4486",
            "fax_number": "406-395-5850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATE",
        "first_name": "GEORGE",
        "middle_name": "WALLACE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-03",
        "last_updated": "2007-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "LA2383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elena Sutherland
• Peter M Sutherland, L.A.C.
• Brittany Swan
• Melissa Ruth Swan, EMT-B
• Stacy Tan
• Chettha Paul Techo, PCLC
• Clarissa The Boy
• William Edward Thomas, O.D.
• Patricia Marie Tilleman, RN
• Wendy Courtnage Tilleman, APRN, FNP-BC

• All providers in Box Elder, MT
• General Practice Dentistry in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.