Organization
CRANIOFACIAL PAIN & SLEEP DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN O BLEVINS DDS (PRESIDENT)
(936) 634-1333
Entity
Organization
Contact information
Practice address
3516 PRESTON RD, SUITE 600, PLANO, TX 75093-8612
(972) 985-4865
(972) 985-7534
Mailing address
5032 CHAMPIONS DR, LUFKIN, TX 75901-7346
(936) 634-1333
(936) 634-1343
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7915
TX
Other
Enumeration date
08/10/2011
Last updated
08/10/2011
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