Healthcare Provider Details

I. General information

NPI: 1649890963
Provider Name (Legal Business Name): HIGHLANDS DENTAL SLEEP MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N MAPLE AVE
COVINGTON VA
24426-1523
US

IV. Provider business mailing address

201 N MAPLE AVE
COVINGTON VA
24426-1523
US

V. Phone/Fax

Practice location:
  • Phone: 540-965-1160
  • Fax:
Mailing address:
  • Phone: 540-965-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DAVID L WHEELER
Title or Position: OWNER
Credential: DDS
Phone: 540-965-1160