Organization
PERLA ORTHODONTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN R WALDER DDS (PRESIDENT, OWNER)
(310) 413-8899
Entity
Organization
Contact information
Practice address
921 W BELT LINE RD, DESOTO, TX 75115-3822
(972) 223-9600
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
24486
TX
Other
Enumeration date
12/21/2010
Last updated
12/21/2010
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