Provider Demographics
NPI:1982478152
Name:MYWISDOM DENTAL PLLC
Entity type:Organization
Organization Name:MYWISDOM DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:UMAMAGESHWARI
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:PURUSHOTHAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-328-4920
Mailing Address - Street 1:500 W WHITESTONE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2271
Mailing Address - Country:US
Mailing Address - Phone:512-528-5454
Mailing Address - Fax:512-528-5455
Practice Address - Street 1:500 W WHITESTONE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2271
Practice Address - Country:US
Practice Address - Phone:512-528-5454
Practice Address - Fax:512-528-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty