Provider Demographics
NPI:1861898637
Name:WYLIE ORTHODONTIC SPECIALISTS
Entity type:Organization
Organization Name:WYLIE ORTHODONTIC SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE AND FINANCE COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ZELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-907-9900
Mailing Address - Street 1:100 N CENTRAL EXPY
Mailing Address - Street 2:#1107
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5332
Mailing Address - Country:US
Mailing Address - Phone:972-907-9900
Mailing Address - Fax:
Practice Address - Street 1:100 N CENTRAL EXPY
Practice Address - Street 2:#1107
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5332
Practice Address - Country:US
Practice Address - Phone:972-907-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYLIE ORTHODONTIC SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty