Provider Demographics
NPI:1215021878
Name:DORSEY, GERALD RICHARD (DDS)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:RICHARD
Last Name:DORSEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 N WOODLAWN
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332
Mailing Address - Country:US
Mailing Address - Phone:361-664-3057
Mailing Address - Fax:361-664-4556
Practice Address - Street 1:80 N WOODLAWN
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332
Practice Address - Country:US
Practice Address - Phone:361-664-3057
Practice Address - Fax:361-664-4556
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice