Provider Demographics
NPI:1043923337
Name:SULPHUR SPRINGS CHILDREN'S DENTISTRY
Entity type:Organization
Organization Name:SULPHUR SPRINGS CHILDREN'S DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:VACULIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-243-4790
Mailing Address - Street 1:226 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2707
Mailing Address - Country:US
Mailing Address - Phone:903-558-1260
Mailing Address - Fax:903-558-1262
Practice Address - Street 1:226 MAIN ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2707
Practice Address - Country:US
Practice Address - Phone:903-558-1260
Practice Address - Fax:903-558-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty