Provider Demographics
NPI:1003122896
Name:CAREWELL DENTAL CLINIC, P.A.
Entity Type:Organization
Organization Name:CAREWELL DENTAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:972-596-0100
Mailing Address - Street 1:6300 STONEWOOD DR
Mailing Address - Street 2:SUITE #210
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5280
Mailing Address - Country:US
Mailing Address - Phone:972-596-0100
Mailing Address - Fax:972-596-7999
Practice Address - Street 1:6300 STONEWOOD DR
Practice Address - Street 2:SUITE #210
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5280
Practice Address - Country:US
Practice Address - Phone:972-596-0100
Practice Address - Fax:972-596-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty