Provider Demographics
NPI:1093871014
Name:BEDWELL, MICHAEL GEORGE (GENERAL DENTIST)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:BEDWELL
Suffix:
Gender:M
Credentials:GENERAL DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 KINWEST PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3409
Mailing Address - Country:US
Mailing Address - Phone:214-461-0425
Mailing Address - Fax:214-461-0429
Practice Address - Street 1:1111 KINWEST PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3409
Practice Address - Country:US
Practice Address - Phone:214-461-0425
Practice Address - Fax:214-461-0429
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice