Provider Demographics
NPI:1205995347
Name:CLOUD, GEORGE H JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
Last Name:CLOUD
Suffix:JR
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 1:3002 GILMER ROAD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604
Mailing Address - Country:US
Mailing Address - Phone:903-759-4366
Mailing Address - Fax:903-759-2663
Practice Address - Street 1:3002 GILMER ROAD
Practice Address - Street 2:SUITE #3
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604
Practice Address - Country:US
Practice Address - Phone:903-759-4366
Practice Address - Fax:903-759-2663
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AC 2180711OtherDEA IDENTIFICATION NO