MEDICARE: WICHITA FALLS DENTURES AND DENTAL IMPLANTS, PLLC.

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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1457208068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WICHITA FALLS DENTURES AND DENTAL IMPLANTS, PLLC.

Provider Business Mailing Address
First Line	:	4446 SOUTHWEST PKWY
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-3331
Country	:	US
Telephone Number	:	940-692-5093
Fax Number	:

Provider Business Practice Location Address
First Line	:	4446 SOUTHWEST PKWY
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-3331
Country	:	US
Telephone Number	:	817-496-2343
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	KARINA DAVILA
Credential	:	BILLING MANAGER
Telephone Number	:	817-496-2343

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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