Provider Demographics
NPI:1003242660
Name:WILLOW BEND ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:WILLOW BEND ORTHODONTICS, PLLC
Other - Org Name:WILLOW BEND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNNETTE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:972-732-1400
Mailing Address - Street 1:5400 W PLANO PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4854
Mailing Address - Country:US
Mailing Address - Phone:972-732-1400
Mailing Address - Fax:972-732-1535
Practice Address - Street 1:5400 W PLANO PKWY STE 250
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4854
Practice Address - Country:US
Practice Address - Phone:972-732-1400
Practice Address - Fax:972-732-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty