Provider Demographics
NPI:1053196469
Name:AFFORDABLE DENTURES & IMPLANTS - TEXAS VI, PLLC
Entity type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - TEXAS VI, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT/CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-251-8846
Mailing Address - Street 1:1522 S NEW RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-1316
Mailing Address - Country:US
Mailing Address - Phone:254-224-6810
Mailing Address - Fax:
Practice Address - Street 1:1522 S NEW RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1316
Practice Address - Country:US
Practice Address - Phone:254-224-6810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty