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NPI Code Detail

MEDICARE: WOODLAWN LAKE DENTAL PARTNERS PLLC

MEDICARE: WOODLAWN LAKE DENTAL PARTNERS PLLC
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1043864648
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOODLAWN LAKE DENTAL PARTNERS PLLC
Provider Business Mailing Address
First Line : 3030 N CENTRAL AVE STE 1500
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2750
Country : US
Telephone Number : 602-427-4066
Fax Number :
Provider Business Practice Location Address
First Line : 1707 WILLIAMS
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78201
Country : US
Telephone Number : 210-390-6115
Fax Number :
Authorized Official
Title or Position : OFFICER
Name : WHITNEY WRIGHT
Credential : DDS
Telephone Number : 480-339-4800
Provider Enumeration Date : 07/31/2019
Last Update Date : 03/19/2024

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Directions to “WOODLAWN LAKE DENTAL PARTNERS PLLC ” Practice Location

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