Healthcare Provider Details

I. General information

NPI: 1407663693
Provider Name (Legal Business Name): TEXAS DENTAL SLEEP SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E CENTRAL TEXAS EXPY
HARKER HEIGHTS TX
76548-1883
US

IV. Provider business mailing address

410 E CENTRAL TEXAS EXPY
HARKER HEIGHTS TX
76548-1883
US

V. Phone/Fax

Practice location:
  • Phone: 512-965-5310
  • Fax:
Mailing address:
  • Phone: 512-965-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: WILL B ETHEREDGE
Title or Position: MANAGER
Credential:
Phone: 512-965-5310