MEDICARE: DENTAL SLEEP CENTERS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1679120604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL SLEEP CENTERS PLLC

Provider Business Mailing Address
First Line	:	800 BERING DR STE 340
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-2131
Country	:	US
Telephone Number	:	832-504-1177
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 BERING DR STE 340
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-2131
Country	:	US
Telephone Number	:	832-504-1177
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TOM K HEDGE
Credential	:	DDS
Telephone Number	:	832-504-1177

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	08/23/2019

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