Provider Demographics
NPI:1417241167
Name:LUIKHAM, GEORGE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:LUIKHAM
Suffix:
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 1:101 N FM 548
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-5685
Mailing Address - Country:US
Mailing Address - Phone:972-552-1224
Mailing Address - Fax:972-692-5433
Practice Address - Street 1:101 N FM 548
Practice Address - Street 2:SUITE 105
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-5685
Practice Address - Country:US
Practice Address - Phone:972-552-1224
Practice Address - Fax:972-692-5433
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist