Provider Demographics
NPI:1326203357
Name:WUNDERBAR, INC
Entity Type:Organization
Organization Name:WUNDERBAR, INC
Other - Org Name:TEJAS SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAF
Authorized Official - Middle Name:JAS
Authorized Official - Last Name:HAERENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-626-3100
Mailing Address - Street 1:PO BOX 311059
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-1059
Mailing Address - Country:US
Mailing Address - Phone:830-625-6916
Mailing Address - Fax:830-625-2148
Practice Address - Street 1:652 N HOUSTON AVE STE I
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4122
Practice Address - Country:US
Practice Address - Phone:830-624-7300
Practice Address - Fax:830-626-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable