Provider Demographics
NPI:1336293158
Name:WILLIAM A STELLENWERF JR DDS PC
Entity Type:Organization
Organization Name:WILLIAM A STELLENWERF JR DDS PC
Other - Org Name:WILLIAM A STELLENWERF DDS & STACY L NORMAN DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:STELLENWERF
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-359-9100
Mailing Address - Street 1:2325 TIMBER SHADOWS DR
Mailing Address - Street 2:BLDG A
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:281-359-9100
Mailing Address - Fax:281-359-0130
Practice Address - Street 1:2325 TIMBER SHADOWS DR
Practice Address - Street 2:BLDG A
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-359-9100
Practice Address - Fax:281-359-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty