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NPI Code Detail

MEDICARE: DR. MARY SARAH PAULOWSKY WILDEY D.D.S.

MEDICARE:  DR. MARY SARAH PAULOWSKY WILDEY  D.D.S.
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
11223P0221XPediatric Dentistry28072TX
2122300000XDentist28072TX

General Provider Information

NPI Number : 1740536739
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY SARAH PAULOWSKY WILDEY D.D.S.
Provider Business Mailing Address
First Line : 400 W HIGHWAY 290 STE B201
Second Line :
City : DRIPPING SPRINGS
State : TX
Zip : 78620-4382
Country : US
Telephone Number : 512-607-5300
Fax Number :
Provider Business Practice Location Address
First Line : 200 W HIGHWAY 290 STE B-201
Second Line :
City : DRIPPING SPRINGS
State : TX
Zip : 78620-3870
Country : US
Telephone Number : 512-607-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2012
Last Update Date : 06/09/2021

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