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Individual
DR. GEORGE SHACKELFORD RICHARDSON II
Active
Individual
DR. GEORGE SHACKELFORD RICHARDSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14684
TX
122300000X
Dentist
1514
NM
122300000X
Dentist
5965
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D14684
BLUE CROSS
TX
Enumeration date
03/30/2007
Last updated
07/08/2007
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