Provider Demographics
NPI:1780060822
Name:TMJ & SLEEP INSTITUTE, INC.
Entity type:Organization
Organization Name:TMJ & SLEEP INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, LVIF, FAACP
Authorized Official - Phone:501-733-0414
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-1170
Mailing Address - Country:US
Mailing Address - Phone:501-733-0414
Mailing Address - Fax:
Practice Address - Street 1:1502 AMELIA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3620
Practice Address - Country:US
Practice Address - Phone:501-733-0414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28411223G0001X
TN101061223G0001X
LA34411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty