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General NPI Number Information
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NPI Number | 1891018297
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Entity Type | Organization
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Legal Business Name | TEXAS ORTHODONTICS FOR KIDS, PC
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Dates
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Enumeration Date | 03/12/2010
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Last Update Date | 03/12/2010
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Provider Practice Location Address
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Address Line | 215 S FM 548 A
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City | FORNEY
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State | TX
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Zip | 75126
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Country | US
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Telephone | 972-564-6064
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Fax |
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Provider Business Mailing Address
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Address Line | 215 S FM 548 A
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City | FORNEY
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State | TX
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Zip | 75126
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Country | US
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Telephone | 972-564-6064
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ ORTHODONTIST
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Name | DR. BENJAMIN R WALDER
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Credential | DDS MS
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Telephone | 972-564-6064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0020802
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0024486
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License Number State | TX
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