Provider Demographics
NPI:1740344928
Name:DASZKO, GEORGE IHOR (DDS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:IHOR
Last Name:DASZKO
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 1:7500 SH 71 WEST
Mailing Address - Street 2:#108
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735
Mailing Address - Country:US
Mailing Address - Phone:512-288-6444
Mailing Address - Fax:512-288-6446
Practice Address - Street 1:7500 STATE HIGHWAY 71 WEST
Practice Address - Street 2:#108
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735
Practice Address - Country:US
Practice Address - Phone:512-288-6444
Practice Address - Fax:512-288-6446
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169659301Medicaid
521740OtherUNITED CONCORDIA