Provider Demographics
NPI:1750494738
Name:WOODLANDS SPECIALTY GROUP PLLC
Entity Type:Organization
Organization Name:WOODLANDS SPECIALTY GROUP PLLC
Other - Org Name:WOODLANDS DENTAL SPECIALTY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR HR/PROFESSIONAL RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-296-8600
Mailing Address - Street 1:26615 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1968
Mailing Address - Country:US
Mailing Address - Phone:281-296-8600
Mailing Address - Fax:281-296-9509
Practice Address - Street 1:25300 BOROUGH PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3552
Practice Address - Country:US
Practice Address - Phone:281-296-0007
Practice Address - Fax:281-296-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223E0200X, 1223P0300X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty