Provider Demographics
NPI:1215263199
Name:DANNY PAUL WINDHAM DDS PC
Entity type:Organization
Organization Name:DANNY PAUL WINDHAM DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:JANICE
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-598-2923
Mailing Address - Street 1:406 CORA ST
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-3610
Mailing Address - Country:US
Mailing Address - Phone:936-598-2923
Mailing Address - Fax:936-598-6412
Practice Address - Street 1:406 CORA ST
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-3611
Practice Address - Country:US
Practice Address - Phone:936-598-2923
Practice Address - Fax:936-598-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123931223G0001X
TX239761223G0001X
TX239351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2070120-01Medicaid
TX2070096-01Medicaid
TX2075038-01Medicaid