George Michael Dougherty III, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D3967 Issued in AZ

Practice address

19369 N. 59TH Avenue
Dental Institute
Glendale, AZ 85308

Phone

(623) 806-7063

Fax

(623) 806-7027

NPI assigned

Nov 23, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 22, 2015 through Sep 22, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Midwestern University

  • Dental Clinic/Center
  • Glendale, AZ
  • NPI 1164744009
  NPD (past)
• Midwestern University

  • Optometrist
  • Glendale, AZ
  • NPI 1891017745
  NPD (past)
• Midwestern University

  • Multi-Specialty Clinic/Center
  • Glendale, AZ
  • NPI 1932206414
  NPD (past)
• Midwestern University

  • Clinic/Center
  • Downers Grove, IL
  • NPI 1538445317
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1290470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290470400000",
    "number": "1609178789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19369 N. 59TH AVENUE",
            "address_2": "DENTAL INSTITUTE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "623-806-7063",
            "fax_number": "623-806-7027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19369 N. 59TH AVENUE",
            "address_2": "DENTAL INSTITUTE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "623-806-7063",
            "fax_number": "623-806-7027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "GEORGE",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-23",
        "last_updated": "2010-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D3967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyeshia Ann Dorsey
• Renee E Doss, O.D.
• Patrick Michael Dostal, D.D.S
• David A Doty, LMSW
• Dona Mae Dougherty, NP-C
• Rick M Dougherty, DDS, ABGD, NDBA
• Shireen D Dow, RD
• Nicole Dowd
• Winter M Dowland, D.O.
• Erin Dowling, LCSW

• Dentist in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.