Provider Demographics
NPI:1174175277
Name:HEALTHY SLEEP OF EAST TEXAS PLLC
Entity type:Organization
Organization Name:HEALTHY SLEEP OF EAST TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:J
Authorized Official - Last Name:VACULIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-243-4790
Mailing Address - Street 1:903 E LENNON DR STE 108
Mailing Address - Street 2:
Mailing Address - City:EMORY
Mailing Address - State:TX
Mailing Address - Zip Code:75440-5229
Mailing Address - Country:US
Mailing Address - Phone:903-953-8500
Mailing Address - Fax:903-953-8501
Practice Address - Street 1:903 E LENNON DR STE 108
Practice Address - Street 2:
Practice Address - City:EMORY
Practice Address - State:TX
Practice Address - Zip Code:75440-5229
Practice Address - Country:US
Practice Address - Phone:903-953-8500
Practice Address - Fax:903-953-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty