Provider Demographics
NPI:1336945203
Name:SLS PERIODONTICS PLLC
Entity type:Organization
Organization Name:SLS PERIODONTICS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LUANNA
Authorized Official - Middle Name:MARIOLA
Authorized Official - Last Name:ZAMBRANA AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:948-888-9771
Mailing Address - Street 1:10110 WOODLANDS PKWY STE 1000
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10110 WOODLANDS PKWY STE 1000
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-2927
Practice Address - Country:US
Practice Address - Phone:713-576-5133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty