Provider Demographics
NPI:1518089283
Name:HITCHCOCK, GEORGIA WYATT (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:WYATT
Last Name:HITCHCOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 BEECHNUT ST
Mailing Address - Street 2:SUITE 374
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-4335
Mailing Address - Country:US
Mailing Address - Phone:713-995-5242
Mailing Address - Fax:
Practice Address - Street 1:7500 BEECHNUT ST
Practice Address - Street 2:SUITE 374
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-4335
Practice Address - Country:US
Practice Address - Phone:713-995-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice