MEDICARE: DR. RICHARD PATRICK GEORGE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	17021	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D17021	OTHER	TX	BLUECROSS BLUESHIELD
2	774319	OTHER	TX	UNITED CONCORDIA

General Provider Information

NPI Number	:	1073674990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD PATRICK GEORGE DDS

Provider Business Mailing Address
First Line	:	7254 BLANCO RD STE 203
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4930
Country	:	US
Telephone Number	:	210-384-0606
Fax Number	:	210-384-0610

Provider Business Practice Location Address
First Line	:	7254 BLANCO RD STE 203
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4930
Country	:	US
Telephone Number	:	210-384-0606
Fax Number	:	210-384-0610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	04/13/2010

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