Provider Demographics
NPI:1942392691
Name:DENTAL STATION FAMILY DENTISTRY, P.A.
Entity Type:Organization
Organization Name:DENTAL STATION FAMILY DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:WINARICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-772-1827
Mailing Address - Street 1:1701 LAKE SUCCESS DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2964
Mailing Address - Country:US
Mailing Address - Phone:254-772-1827
Mailing Address - Fax:254-772-9594
Practice Address - Street 1:1701 LAKE SUCCESS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2964
Practice Address - Country:US
Practice Address - Phone:254-772-1827
Practice Address - Fax:254-772-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXB206051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty