Provider Demographics
NPI:1184474322
Name:TEXAS DENTAL SLEEP SERVICES PLLC
Entity type:Organization
Organization Name:TEXAS DENTAL SLEEP SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-291-2148
Mailing Address - Street 1:7028 SPANISH OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76182-3275
Mailing Address - Country:US
Mailing Address - Phone:817-291-2148
Mailing Address - Fax:469-519-8762
Practice Address - Street 1:6701 SANGER AVE STE 101
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7737
Practice Address - Country:US
Practice Address - Phone:254-776-6241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS DENTAL SLEEP SERVICES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty