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DR. GEORGE MICHAEL DOUGHERTY III DDS
NPI 1609178789
Dentist in Glendale, AZ

Active since November 23, 2010Opted out of Medicare · through Sep 22, 2027
19369 N. 59TH AVENUE, DENTAL INSTITUTE, GLENDALE, AZ 85308(623) 806-7063(623) 806-7027 Get Directions Write a Review

NPPES record last updated: November 23, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. George Michael Dougherty Iii Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. GEORGE MICHAEL DOUGHERTY III DDS (NPI 1609178789) is an individual dentist in Glendale, Arizona, licensed in Arizona (D3967) and active in the NPI registry since November 2010. He has opted out of Medicare through September 22, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1609178789
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameDR. GEORGE MICHAEL DOUGHERTY IIICredential: DDS
Location Address19369 N. 59TH AVENUE, DENTAL INSTITUTEGlendale, AZ 85308
Mailing Address19369 N. 59th Avenue, Dental InstituteGlendale, AZ 85308 · (623) 806-7063 · Fax (623) 806-7027
Phone(623) 806-7063
Fax(623) 806-7027
Sole ProprietorYes
Enumeration DateNovember 23, 2010
✔ NPI 1609178789 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in AZ · D3967
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
19369 N. 59TH AVENUE, Glendale, AZ 85308
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. George Michael Dougherty Iii Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 22, 2015 through September 22, 2027.

Opt-Out Effective DateSeptember 22, 2015
Opt-Out In Effect ThroughSeptember 22, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85308 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$69.24 typical visit price
range $17.72 – $137.41
Typical copayment $17.31 (range $4.43 – $34.35)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is George Dougherty's NPI number?

The NPI number for George Dougherty is 1609178789. It was assigned to this individual provider in the NPPES registry on November 23, 2010.

Where is George Dougherty located?

George Dougherty practices at 19369 N. 59th Avenue Dental Institute, Glendale, AZ 85308. The listed phone number is (623) 806-7063.

What is George Dougherty's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is George Dougherty enrolled in Medicare?

No. George Dougherty has opted out of Medicare through September 22, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for George Dougherty was last updated on November 23, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.