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General NPI Number Information
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NPI Number | 1225409139
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Entity Type | Organization
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Legal Business Name | RWPK LLC
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 715 HILL COUNTRY DR STE 5
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City | KERRVILLE
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State | TX
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Zip | 78028-5965
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Country | US
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Telephone | 830-255-4197
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Fax |
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Provider Business Mailing Address
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Address Line | 715 HILL COUNTRY DR STE 5
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City | KERRVILLE
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State | TX
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Zip | 78028-5965
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Country | US
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Telephone | 830-255-4197
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REX ELWYN WILDEY
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Credential | DDS
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Telephone | 830-255-4197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 25425
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License Number State | TX
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