Provider Demographics
NPI:1316132392
Name:WDW DENTAL ASSOCIATES
Entity type:Organization
Organization Name:WDW DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-242-1592
Mailing Address - Street 1:2440 N JOSEY LN
Mailing Address - Street 2:#102
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1668
Mailing Address - Country:US
Mailing Address - Phone:972-242-1592
Mailing Address - Fax:
Practice Address - Street 1:2440 N JOSEY LN
Practice Address - Street 2:#102
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1668
Practice Address - Country:US
Practice Address - Phone:972-242-1592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty