Provider Demographics
NPI:1467760017
Name:FLOWER MOUND ORTHODONTICS, P.A.
Entity Type:Organization
Organization Name:FLOWER MOUND ORTHODONTICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-539-4747
Mailing Address - Street 1:2845 MORRISS RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3662
Mailing Address - Country:US
Mailing Address - Phone:972-539-4747
Mailing Address - Fax:
Practice Address - Street 1:2845 MORRISS RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3662
Practice Address - Country:US
Practice Address - Phone:972-539-4747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty