Provider Demographics
NPI:1679022297
Name:HOUSTON DENTAL SLEEP THERAPY
Entity Type:Organization
Organization Name:HOUSTON DENTAL SLEEP THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-218-0500
Mailing Address - Street 1:2493 S BRAESWOOD BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4332
Mailing Address - Country:US
Mailing Address - Phone:713-218-0500
Mailing Address - Fax:713-218-0533
Practice Address - Street 1:2493 S BRAESWOOD BLVD STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4332
Practice Address - Country:US
Practice Address - Phone:713-218-0500
Practice Address - Fax:713-218-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty