Provider Demographics
NPI:1083243570
Name:WINDHAVEN PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:WINDHAVEN PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:469-473-6707
Mailing Address - Street 1:14295 ALIS LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0286
Mailing Address - Country:US
Mailing Address - Phone:469-473-6707
Mailing Address - Fax:
Practice Address - Street 1:27045 E UNIVERSITY DR STE 2A
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-2746
Practice Address - Country:US
Practice Address - Phone:469-277-1787
Practice Address - Fax:469-277-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty