Provider Demographics
NPI:1063065472
Name:WS DENTAL
Entity type:Organization
Organization Name:WS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:WALLACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-216-9687
Mailing Address - Street 1:6801 S IH 35 STE 1-D
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-4824
Mailing Address - Country:US
Mailing Address - Phone:512-608-4420
Mailing Address - Fax:512-608-4424
Practice Address - Street 1:6801 S IH 35 STE 1-D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-4824
Practice Address - Country:US
Practice Address - Phone:512-608-4420
Practice Address - Fax:512-608-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty