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General NPI Number Information
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NPI Number | 1093401424
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Entity Type | Organization
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Legal Business Name | ADVANTAGE DENTAL ORAL HEALTH CENTER OF TEXAS, PC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 9510 BEECHNUT ST # A1
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City | HOUSTON
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State | TX
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Zip | 77036-6608
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Country | US
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Telephone | 832-476-9991
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Fax |
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Provider Business Mailing Address
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Address Line | 3322 W END AVE STE 400
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City | NASHVILLE
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State | TN
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Zip | 37203-6805
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Country | US
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Telephone | 629-999-5014
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Fax |
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Authorized Official
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Title or Position | SR MANAGER, L&C
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Name | SHERRIE EDMONDSON
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Credential |
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Telephone | 629-999-5014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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