MEDICARE: DENTAL SLEEP MEDICINE, 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	122300000X	Dentist	DEN00010690	CO

General Provider Information

NPI Number	:	1396159950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL SLEEP MEDICINE, LLC

Provider Business Mailing Address
First Line	:	17011 LINCOLN AVENUE
Second Line	:	#561
City	:	PARKER
State	:	CO
Zip	:	80134
Country	:	US
Telephone Number	:	303-503-3260
Fax Number	:	303-974-1166

Provider Business Practice Location Address
First Line	:	9450 E MISSISSIPPI AVE UNIT A
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-2427
Country	:	US
Telephone Number	:	303-503-3260
Fax Number	:	303-974-1166

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VICTORIA SHKLOVSKY
Credential	:	D.D.S.
Telephone Number	:	303-503-3260

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	10/22/2021

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