Healthcare Provider Details

I. General information

NPI: 1891468112
Provider Name (Legal Business Name): TEXAS DENTAL SLEEP SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12505 HYMEADOW DR STE 2E
AUSTIN TX
78750-1866
US

IV. Provider business mailing address

12505 HYMEADOW DR STE 2E
AUSTIN TX
78750-1866
US

V. Phone/Fax

Practice location:
  • Phone: 512-636-8120
  • Fax: 512-338-8192
Mailing address:
  • Phone: 512-636-8120
  • Fax: 512-338-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL REED
Title or Position: OWNER
Credential: DDS
Phone: 214-476-1706