Provider Demographics
NPI:1407969009
Name:WOODLANDS ELITE DENTAL PARTNERS, PLLC
Entity Type:Organization
Organization Name:WOODLANDS ELITE DENTAL PARTNERS, PLLC
Other - Org Name:WOODLANDS DENTAL PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR. OPERATIONS/PROFESIONAL RELATIO
Authorized Official - Prefix:
Authorized Official - First Name:DEA ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-296-8600
Mailing Address - Street 1:26615 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1968
Mailing Address - Country:US
Mailing Address - Phone:281-296-8600
Mailing Address - Fax:281-296-9509
Practice Address - Street 1:25300 BOROUGH PARK DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3552
Practice Address - Country:US
Practice Address - Phone:281-296-0052
Practice Address - Fax:281-296-0118
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLAN HAMBURG D.D.S.,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-16
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163478401Medicaid