Provider Demographics
NPI:1134652720
Name:WILDFLOWER DENTAL AND ORTHODONTICS, PLLC
Entity type:Organization
Organization Name:WILDFLOWER DENTAL AND ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:WALKINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-872-2828
Mailing Address - Street 1:2111 E UNIVERSITY DR
Mailing Address - Street 2:20
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-7240
Mailing Address - Country:US
Mailing Address - Phone:214-872-2828
Mailing Address - Fax:
Practice Address - Street 1:2111 E UNIVERSITY DR
Practice Address - Street 2:20
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-7240
Practice Address - Country:US
Practice Address - Phone:214-872-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty