Provider Demographics
NPI:1073051777
Name:WILLIAMS SQUARE DENTAL, PLLC
Entity Type:Organization
Organization Name:WILLIAMS SQUARE DENTAL, PLLC
Other - Org Name:WILLIAMS SQUARE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-702-0708
Mailing Address - Street 1:15660 DALLAS PKWY
Mailing Address - Street 2:SUITE 925
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-3348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5205 N O'CONNOR BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039
Practice Address - Country:US
Practice Address - Phone:972-556-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty