MEDICARE: ADVANTAGE DENTAL ORAL HEALTH CENTER OF TEXAS, PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223P0221X	Pediatric Dentistry
3	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1780469767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE DENTAL ORAL HEALTH CENTER OF TEXAS, PC

Provider Business Mailing Address
First Line	:	3322 W END AVE STE 400
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-6805
Country	:	US
Telephone Number	:	629-999-5014
Fax Number	:

Provider Business Practice Location Address
First Line	:	6181 BONNIE VIEW RD # 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-5149
Country	:	US
Telephone Number	:	629-999-5014
Fax Number	:

Authorized Official
Title or Position	:	SR MANAGER
Name	:	SHERRIE EDMONDSON
Credential	:
Telephone Number	:	629-999-5014

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	08/29/2023

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