Provider Demographics
NPI:1104246131
Name:WSD DENTAL VENTURES LLLP
Entity type:Organization
Organization Name:WSD DENTAL VENTURES LLLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-779-5020
Mailing Address - Street 1:500 W WHITESTONE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2245
Mailing Address - Country:US
Mailing Address - Phone:512-719-4449
Mailing Address - Fax:512-996-0134
Practice Address - Street 1:500 W WHITESTONE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2245
Practice Address - Country:US
Practice Address - Phone:512-719-4449
Practice Address - Fax:512-996-0134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITESTONE DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty