Provider Demographics
NPI:1609272319
Name:JYRON WALLS ,DDS
Entity Type:Organization
Organization Name:JYRON WALLS ,DDS
Other - Org Name:SUNNYSIDE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-738-1999
Mailing Address - Street 1:4040 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-1158
Mailing Address - Country:US
Mailing Address - Phone:713-738-1999
Mailing Address - Fax:
Practice Address - Street 1:4040 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-1158
Practice Address - Country:US
Practice Address - Phone:713-738-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty