| Doctor Name: | GEORGE THOMAS WICKERSHAM |
| NPI Number: | 1083770465 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 17875 |
| Business Practice Address: | 2260 Cross Timberes Rd Ste A Flower Mound, TX - 75028 |
| Business Phone Number: | 9728742800 |
| Business Fax Number: | 9725390165 |
| Mailing Address: | 2260 Cross Timberes Rd, Ste A FLOWER MOUND |
| State: | TX |
| Postal Code: | 75028 |
| Phone Number: | 9728742800 |
| Fax Number: | 9725390165 |
| NPI Enumeration Date: | 12/29/2006 |
| NPI Last Update Date: | 10/03/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 17875 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |