Provider Demographics
NPI:1144597931
Name:SEDADENT ANESTHESIA SERVICES
Entity Type:Organization
Organization Name:SEDADENT ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAROM
Authorized Official - Middle Name:COOPER
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-940-8601
Mailing Address - Street 1:1608 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1513
Mailing Address - Country:US
Mailing Address - Phone:512-909-3171
Mailing Address - Fax:512-246-3678
Practice Address - Street 1:1608 OAK FOREST DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-1513
Practice Address - Country:US
Practice Address - Phone:512-909-3171
Practice Address - Fax:512-246-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1949372Medicaid