Provider Demographics
NPI:1265552368
Name:RICHARDSON, GEORGE SHACKELFORD II (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:SHACKELFORD
Last Name:RICHARDSON
Suffix:II
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 1:16000 PRESTON RD
Mailing Address - Street 2:#300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-3567
Mailing Address - Country:US
Mailing Address - Phone:972-490-6268
Mailing Address - Fax:972-490-0111
Practice Address - Street 1:16000 PRESTON RD
Practice Address - Street 2:#300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-3567
Practice Address - Country:US
Practice Address - Phone:972-490-6268
Practice Address - Fax:972-490-0111
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX14684122300000X
KS5965122300000X
NM1514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD14684OtherBLUE CROSS