Organization
SEDADENT ANESTHESIA SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAROM COOPER HEATON DDS (OWNER)
(512) 940-8601
Entity
Organization
Contact information
Practice address
1608 OAK FOREST DR, ROUND ROCK, TX 78681-1513
(512) 909-3171
(512) 246-3678
Mailing address
1608 OAK FOREST DR, ROUND ROCK, TX 78681-1513
(512) 909-3171
(512) 246-3678
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1949372
—
TX
Enumeration date
11/21/2011
Last updated
07/08/2013
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