Provider Demographics
NPI:1417053513
Name:PADDOCK, ARTHUR GEORGE III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:GEORGE
Last Name:PADDOCK
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 SHILOH RD
Mailing Address - Street 2:SUITE C100
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1431
Mailing Address - Country:US
Mailing Address - Phone:972-310-0331
Mailing Address - Fax:
Practice Address - Street 1:921 SHILOH RD
Practice Address - Street 2:SUITE C100
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1431
Practice Address - Country:US
Practice Address - Phone:972-310-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice