Active NPI
George Thomas Wickersham
- Pediatric Dentistry
- Flower Mound, TX
National Provider Identifier
1083770465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 17875
- Practice address
- 2260 Cross Timberes Rd
Ste a
Flower Mound, TX 75028 - Phone
- (972) 874-2800
- Fax
- (972) 539-0165
- NPI assigned
- Dec 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 17875 | TX | Primary |
Addresses
Primary practice location
2260 Cross Timberes Rd
Ste a
Flower Mound, TX 75028
Mailing address
2260 Cross Timberes Rd
Ste a
Flower Mound, TX 75028
Phone (972) 874-2800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17875 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191369600000",
"number": "1083770465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2260 CROSS TIMBERES RD",
"address_2": "STE A",
"city": "FLOWER MOUND",
"state": "TX",
"postal_code": "75028",
"telephone_number": "972-874-2800",
"fax_number": "972-539-0165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2260 CROSS TIMBERES RD",
"address_2": "STE A",
"city": "FLOWER MOUND",
"state": "TX",
"postal_code": "75028",
"telephone_number": "972-874-2800",
"fax_number": "972-539-0165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKERSHAM",
"first_name": "GEORGE",
"middle_name": "THOMAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-29",
"last_updated": "2007-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "17875",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flower Mound, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.