Organization
SPECIALTY DENTAL MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM B USDAN (CEO)
(615) 727-3060
Entity
Organization
Contact information
Practice address
5400 BRODIE LANE, SUITE 260, SUNSET VALLEY, TX 78745-2525
(512) 255-5900
Mailing address
1500 S AW GRIMES BLVD, SUITE 190, ROUND ROCK, TX 78664
(512) 255-5900
(512) 485-2879
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
03/07/2022
Last updated
02/28/2023
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