Organization Active NPI

Healthy Sleep of East Texas PLLC

  • General Practice Dentistry
  • Emory, TX
National Provider Identifier
1174175277
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
HEALTHY SLEEP OF EAST TEXAS PLLC
Practice address
903 E Lennon Dr Ste 108
Emory, TX 75440-5229
Phone
(903) 953-8500
Fax
(903) 953-8501
NPI assigned
Jul 10, 2019
Last updated
Feb 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bennett J Vaculik, DDSNPI 1174641542
Title
Dentist
Phone
(903) 243-4790

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary
Customized Equipment (DME) 332BC3200X NU

Addresses

Primary practice location

903 E Lennon Dr Ste 108
Emory, TX 75440-5229

Mailing address

903 E Lennon Dr Ste 108
Emory, TX 75440-5229
Phone (903) 953-8500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200724001954 TX DME Supplier - Oral Surgery - Dentist 0345664249 Practice locations: Emory, TX

National Provider Directory

National Provider Directory

Locations

903 E Lennon Dr
Ste 108
Emory, TX 75440
Phone (903) 474-6010

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1174175277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 E LENNON DR STE 108",
            "city": "EMORY",
            "state": "TX",
            "postal_code": "754405229",
            "telephone_number": "903-953-8500",
            "fax_number": "903-953-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 E LENNON DR STE 108",
            "city": "EMORY",
            "state": "TX",
            "postal_code": "754405229",
            "telephone_number": "903-953-8500",
            "fax_number": "903-953-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY SLEEP OF EAST TEXAS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-10",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "VACULIK",
        "authorized_official_first_name": "BENNETT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "903-243-4790",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Emory, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.