Provider Demographics
NPI:1558725549
Name:TEXAS ORTHODONTICS DALLAS PLLC
Entity Type:Organization
Organization Name:TEXAS ORTHODONTICS DALLAS PLLC
Other - Org Name:TEXAS ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WALDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-215-7645
Mailing Address - Street 1:215 S FM 548
Mailing Address - Street 2:STE A
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4129
Mailing Address - Country:US
Mailing Address - Phone:972-215-7645
Mailing Address - Fax:
Practice Address - Street 1:2731 W NORTHWEST HWY
Practice Address - Street 2:#104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4788
Practice Address - Country:US
Practice Address - Phone:972-215-7645
Practice Address - Fax:888-302-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty