Provider Demographics
NPI:1508639766
Name:UNTIE PLLC
Entity Type:Organization
Organization Name:UNTIE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:REX
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILDEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-417-4181
Mailing Address - Street 1:PO BOX 782387
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-2387
Mailing Address - Country:US
Mailing Address - Phone:210-971-6018
Mailing Address - Fax:210-504-4969
Practice Address - Street 1:10003 NW MILITARY HWY STE 3207
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1892
Practice Address - Country:US
Practice Address - Phone:210-417-4181
Practice Address - Fax:210-504-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty