Provider Demographics
NPI:1568854818
Name:DALLAS CENTER FOR ORAL HEALTH AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:DALLAS CENTER FOR ORAL HEALTH AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-566-6300
Mailing Address - Street 1:7777 FOREST LN STE A309
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2507
Mailing Address - Country:US
Mailing Address - Phone:972-566-6300
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE A309
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2507
Practice Address - Country:US
Practice Address - Phone:972-566-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179161223G0001X
TX142981223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty