MEDICARE: DR. GEORGE DALE DODD 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	13539	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396771200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE DALE DODD DDS

Provider Business Mailing Address
First Line	:	4121 FAIRMONT PKWY
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-3301
Country	:	US
Telephone Number	:	281-506-7800
Fax Number	:	281-506-7805

Provider Business Practice Location Address
First Line	:	4121 FAIRMONT PKWY
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-3301
Country	:	US
Telephone Number	:	281-506-7800
Fax Number	:	281-506-7805

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	06/27/2015

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