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Individual

DR. GEORGE SHACKELFORD RICHARDSON II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
16000 PRESTON RD, #300, DALLAS, TX 75248-3567
(972) 490-6268
(972) 490-0111
Mailing address
16000 PRESTON RD, #300, DALLAS, TX 75248-3567
(972) 490-6268
(972) 490-0111

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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