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General NPI Number Information
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NPI Number | 1912610072
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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 | 01/03/2023
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 8062 FERGUSON RD
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City | DALLAS
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State | TX
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Zip | 75228-5848
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Country | US
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Telephone | 214-227-7215
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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, LICENSING CREDENTIALING
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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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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