Provider Demographics
NPI:1376009233
Name:DENTAL SLEEP MEDICINE OF NORTH TEXAS, PA
Entity Type:Organization
Organization Name:DENTAL SLEEP MEDICINE OF NORTH TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-207-5267
Mailing Address - Street 1:125 PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165
Mailing Address - Country:US
Mailing Address - Phone:972-737-5337
Mailing Address - Fax:
Practice Address - Street 1:125 PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165
Practice Address - Country:US
Practice Address - Phone:972-737-5337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty