MEDICARE: WILLOW PARK DENTAL CENTER PA

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	18838	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B188381	OTHER	TX	DELTA CHIP

General Provider Information

NPI Number	:	1619087970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW PARK DENTAL CENTER PA

Provider Business Mailing Address
First Line	:	13715 TOMBALL PARKWAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086
Country	:	US
Telephone Number	:	281-543-8520
Fax Number	:	281-260-8593

Provider Business Practice Location Address
First Line	:	13715 TOMBALL PARKWAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086
Country	:	US
Telephone Number	:	281-260-8888
Fax Number	:	281-260-8593

Authorized Official
Title or Position	:	PRESIDENT DENTIST
Name	:	DR. TU REN
Credential	:	DDS
Telephone Number	:	281-543-8520

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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Directions to “WILLOW PARK DENTAL CENTER PA ” Practice Location

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