Healthcare Provider Details

I. General information

NPI: 1144597931
Provider Name (Legal Business Name): SEDADENT ANESTHESIA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 OAK FOREST DR
ROUND ROCK TX
78681-1513
US

IV. Provider business mailing address

1608 OAK FOREST DR
ROUND ROCK TX
78681-1513
US

V. Phone/Fax

Practice location:
  • Phone: 512-909-3171
  • Fax: 512-246-3678
Mailing address:
  • Phone: 512-909-3171
  • Fax: 512-246-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAROM COOPER HEATON
Title or Position: OWNER
Credential: DDS
Phone: 512-940-8601