Provider Demographics
NPI:1508940933
Name:WAMBAUGH, WILLIAM CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:WAMBAUGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 RESEARCH FOREST DRIVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4901
Mailing Address - Country:US
Mailing Address - Phone:281-367-3348
Mailing Address - Fax:281-292-9563
Practice Address - Street 1:4747 RESEARCH FOREST DRIVE
Practice Address - Street 2:SUITE 410
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-4901
Practice Address - Country:US
Practice Address - Phone:281-367-3348
Practice Address - Fax:281-292-9563
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist