MEDICARE: PRECISION DENTAL SLEEP THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22DI02246400	NJ

General Provider Information

NPI Number	:	1306347877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION DENTAL SLEEP THERAPY LLC

Provider Business Mailing Address
First Line	:	13 MAIN ST STE 7
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-1933
Country	:	US
Telephone Number	:	973-729-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 MAIN ST STE 7
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-1933
Country	:	US
Telephone Number	:	973-729-5900
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. ANNA PATRAS
Credential	:	DMD
Telephone Number	:	973-729-5900

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	02/21/2018

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