Provider Demographics
NPI:1619087970
Name:WILLOW PARK DENTAL CENTER PA
Entity Type:Organization
Organization Name:WILLOW PARK DENTAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TU
Authorized Official - Middle Name:
Authorized Official - Last Name:REN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-543-8520
Mailing Address - Street 1:13715 TOMBALL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086
Mailing Address - Country:US
Mailing Address - Phone:281-543-8520
Mailing Address - Fax:281-260-8593
Practice Address - Street 1:13715 TOMBALL PARKWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086
Practice Address - Country:US
Practice Address - Phone:281-260-8888
Practice Address - Fax:281-260-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB188381OtherDELTA CHIP