Healthcare Provider Details

I. General information

NPI: 1760442909
Provider Name (Legal Business Name): GEORGE ARTHUR TANKSLEY JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 RESEARCH BLVD SUITE 302
AUSTIN TX
78759-5798
US

IV. Provider business mailing address

1218 SW MILITARY DR
SAN ANTONIO TX
78221-1535
US

V. Phone/Fax

Practice location:
  • Phone: 512-568-3500
  • Fax: 512-372-4528
Mailing address:
  • Phone: 210-928-2814
  • Fax: 210-928-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4619T
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02044900
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number23816
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: