Healthcare Provider Details

I. General information

NPI: 1003555210
Provider Name (Legal Business Name): WHITNEY VRAZEL DDS, MDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2022
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W MONTGOMERY ST STE 110
WILLIS TX
77378-8829
US

IV. Provider business mailing address

29806 N LEGENDS CHASE CIR
SPRING TX
77386-2050
US

V. Phone/Fax

Practice location:
  • Phone: 936-228-3055
  • Fax:
Mailing address:
  • Phone: 936-446-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number35663
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: