Provider Demographics
NPI:1912185737
Name:HENRY JAKOB WACHTENDORF D.D.S.,P.A.
Entity Type:Organization
Organization Name:HENRY JAKOB WACHTENDORF D.D.S.,P.A.
Other - Org Name:COMFORT CARE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:JAKOB
Authorized Official - Last Name:WACHTENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-635-9919
Mailing Address - Street 1:2763 FM 35
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-2803
Mailing Address - Country:US
Mailing Address - Phone:972-635-9919
Mailing Address - Fax:972-635-9918
Practice Address - Street 1:2763 FM 35
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-2803
Practice Address - Country:US
Practice Address - Phone:972-635-9919
Practice Address - Fax:972-635-9918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty