Organization
COLUMBUS CHILDREN'S DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN WILLIS DMD (OWNER)
(979) 733-8844
Entity
Organization
Contact information
Practice address
106 SHULT DR STE AB, COLUMBUS, TX 78934-3016
(979) 733-8844
Mailing address
106 SHULT DR STE AB, COLUMBUS, TX 78934-3016
(979) 733-8844
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
261QD0000X
Dental Clinic/Center
27076
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27076
DENTAL LICENSE
TX
Enumeration date
07/18/2016
Last updated
03/07/2025
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