# APPLEWHITE DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Koala Center for Sleep Disorders TX-1
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205211174
- **Authorized official:** DERRICK TAYLOR (OFFICE MANAGER/CO-OWNER)
- **Authorized official phone:** (817) 913-3537

## Contact information

- **Practice address:** 4927 LAKE RIDGE PKWY, SUITE 140, GRAND PRAIRIE, TX 75052-3087
- **Practice address phone:** (817) 913-3537
- **Mailing address:** 4927 LAKE RIDGE PKWY, SUITE 140, GRAND PRAIRIE, TX 75052-3087

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 18732 | TX | Yes |

## Other

- **Enumeration date:** 07/21/2015
- **Last updated:** 12/08/2015