Organization
VAN DE WALLE FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS VAN DE WALLE (PRESIDENT)
(512) 878-2540
Entity
Organization
Contact information
Practice address
111 WILLOWS SPRINGS DR., SAN MARCOS, TX 78666-6076
(512) 878-2540
Mailing address
111 WILLOWS SPRINGS DR, SAN MARCOS, TX 78666-6076
(512) 878-2540
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
21761
TX
Other
Enumeration date
04/09/2012
Last updated
06/02/2016
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