Healthcare Provider Details

I. General information

NPI: 1699182618
Provider Name (Legal Business Name): MEDICAL CENTER SLEEP SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 ORCHARD ST
WEBSTER TX
77598-4109
US

IV. Provider business mailing address

521 ORCHARD ST
WEBSTER TX
77598-4109
US

V. Phone/Fax

Practice location:
  • Phone: 281-332-7565
  • Fax: 281-332-0617
Mailing address:
  • Phone: 281-332-7565
  • Fax: 281-332-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number15127
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number15127
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number15127
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number15127
License Number StateTX

VIII. Authorized Official

Name: DR. CRYSTAL MARSHALL BRADY
Title or Position: OWNER
Credential: D.D.S.
Phone: 281-703-4115