Organization
TEXAS ORTHODONTIC SPECIALIST
Active
Organization
TEXAS ORTHODONTIC SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN R WALDER D.D.S. (ORTHODONTIST/PRESIDENT)
(972) 215-7645
Entity
Organization
Contact information
Practice address
8608 PRESTON RD STE 112, PLANO, TX 75024-3317
(972) 215-7645
Mailing address
215 S FM 548 STE A, FORNEY, TX 75126-4130
(972) 215-7645
(888) 302-6633
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
11/10/2011
Last updated
11/10/2011
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