Provider Demographics
NPI:1235393596
Name:JWCM, LLC
Entity Type:Organization
Organization Name:JWCM, LLC
Other - Org Name:HILL COUNTRY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:WALTRIP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-755-6475
Mailing Address - Street 1:30875 INTERSTATE 10 W
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9252
Mailing Address - Country:US
Mailing Address - Phone:830-755-6475
Mailing Address - Fax:
Practice Address - Street 1:30875 INTERSTATE 10 W
Practice Address - Street 2:SUITE B
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9252
Practice Address - Country:US
Practice Address - Phone:830-755-6475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19475261QD0000X
TX19842261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental