# TAZEWELL DENTAL SLEEP THERAPY,LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548506975
- **Authorized official:** DR. RONALD WAYNE HOUSEHOLDER D.D.S (OWNER)
- **Authorized official phone:** (276) 979-5796

## Contact information

- **Practice address:** 316 BEN BOLT AVE, TAZEWELL, VA 24651-9703
- **Practice address phone:** (276) 979-5796
- **Practice address fax:** (276) 988-5866
- **Mailing address:** 125 BEN BOLT AVE, TAZEWELL, VA 24651-9703
- **Mailing address phone:** (276) 979-5796
- **Mailing address fax:** (276) 988-5866

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401005792 | VA | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 12/12/2012
- **Last updated:** 07/21/2022