WATERFORD DENTAL SPECIALISTS, PLLC; NPI #1912150111

Contact Information

WATERFORD DENTAL SPECIALISTS, PLLC

5246 S. 31ST ST.
TEMPLE, TX 76502

Phone: 254-773-4444
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Oral and Maxillofacial Surgery	261QS0112X

Indicates primary specialty

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NPI Profile & details for WATERFORD DENTAL SPECIALISTS, PLLC

NPI Number 1912150111

LBN Legal business name WATERFORD DENTAL SPECIALISTS, PLLC

Authorized official TODD EVANS - (OWNER)

Entity Organization

Organization subpart ¹ No

Enumeration date 10/31/2008

Last updated 10/31/2008 - About 18 years ago

Identifiers

License #

22583

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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