Healthcare Provider Details

I. General information

NPI: 1750494738
Provider Name (Legal Business Name): WOODLANDS SPECIALTY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25300 BOROUGH PARK DR SUITE A
SPRING TX
77380-3552
US

IV. Provider business mailing address

26615 OAK RIDGE DR
THE WOODLANDS TX
77380-1968
US

V. Phone/Fax

Practice location:
  • Phone: 281-296-0007
  • Fax: 281-296-0118
Mailing address:
  • Phone: 281-296-8600
  • Fax: 281-296-9509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateTX

VIII. Authorized Official

Name: MARY BONEY
Title or Position: DIR HR/PROFESSIONAL RELATIONS
Credential:
Phone: 281-296-8600