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General NPI Number Information
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NPI Number | 1952680837
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Entity Type | Organization
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Legal Business Name | CRANIOFACIAL PAIN & SLEEP DENTISTRY, PA
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 3516 PRESTON RD SUITE 600
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City | PLANO
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State | TX
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Zip | 75093-8612
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Country | US
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Telephone | 972-985-4865
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Fax | 972-985-7534
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Provider Business Mailing Address
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Address Line | 5032 CHAMPIONS DR
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City | LUFKIN
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State | TX
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Zip | 75901-7346
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Country | US
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Telephone | 936-634-1333
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Fax | 936-634-1343
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRYAN O BLEVINS
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Credential | DDS
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Telephone | 936-634-1333
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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 | 7915
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License Number State | TX
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