Provider Demographics
NPI:1699361725
Name:WOODLAKE FAMILY DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:WOODLAKE FAMILY DENTAL GROUP PLLC
Other - Org Name:WOODLAKE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:XIAOYU
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-489-0008
Mailing Address - Street 1:2539 S GESSNER RD STE 7
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2028
Mailing Address - Country:US
Mailing Address - Phone:713-489-0008
Mailing Address - Fax:713-338-2288
Practice Address - Street 1:2539 S GESSNER RD STE 7
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2028
Practice Address - Country:US
Practice Address - Phone:713-489-0008
Practice Address - Fax:713-338-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-13
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty