NPIMap

Organization Active NPI

TX Southern Dental PPO PC

Doing business as Woodland Lakes Dental Studio

  • Dentist
  • Conroe, TX
National Provider Identifier
1306616867
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
TX SOUTHERN DENTAL PPO PC
Doing business as
Woodland Lakes Dental Studio
Practice address
525 Woodland Square Blvd Ste 160
Conroe, TX 77384-2212
Phone
(936) 271-3500
NPI assigned
Jan 5, 2024
Last updated
Jan 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TX SOUTHERN DENTAL PPO PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christine Nelson
Title
VP, Revenue Cycle
Phone
(469) 450-6482

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

525 Woodland Square Blvd Ste 160
Conroe, TX 77384-2212

Mailing address

5830 Granite Pkwy Ste 780
Plano, TX 75024-6775

Other names 1

  • Woodland Lakes Dental Studio Doing business as

National Provider Directory

National Provider Directory
Tax ID family
TX Southern Dental PPO PC44 organizations share this tax ID, including this one
Part of
TX Southern Dental PPO PC

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Locations

525 Woodland Square Blvd
Ste 160
Conroe, TX 77384
Phone (936) 271-3500

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1306616867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5830 GRANITE PKWY STE 780",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750246775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 WOODLAND SQUARE BLVD STE 160",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773842212",
            "telephone_number": "936-271-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TX SOUTHERN DENTAL PPO PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TX SOUTHERN DENTAL PPO PC",
        "enumeration_date": "2024-01-05",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "VP, REVENUE CYCLE",
        "authorized_official_telephone_number": "469-450-6482"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodland Lakes Dental Studio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.