Provider Demographics
NPI:1558627687
Name:WOODLAKE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WOODLAKE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-793-0476
Mailing Address - Street 1:2721 LITTLE ELM PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-6671
Mailing Address - Country:US
Mailing Address - Phone:972-793-0476
Mailing Address - Fax:
Practice Address - Street 1:2721 LITTLE ELM PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-6671
Practice Address - Country:US
Practice Address - Phone:972-793-0476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty