Provider Demographics
NPI:1740339191
Name:WOODLANDS ENDODONTICS, P.C.
Entity type:Organization
Organization Name:WOODLANDS ENDODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:MIZE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-681-0100
Mailing Address - Street 1:9001 FOREST XING
Mailing Address - Street 2:SUITE G
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1180
Mailing Address - Country:US
Mailing Address - Phone:281-681-0100
Mailing Address - Fax:
Practice Address - Street 1:9001 FOREST XING
Practice Address - Street 2:SUITE G
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1180
Practice Address - Country:US
Practice Address - Phone:281-681-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176571223E0200X
TX192171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty