MEDICARE: BLUE SKY SLEEP SOLUTIONS

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1790432839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE SKY SLEEP SOLUTIONS

Provider Business Mailing Address
First Line	:	10555 MONTGOMERY BLVD NE STE 160
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3872
Country	:	US
Telephone Number	:	505-275-2492
Fax Number	:

Provider Business Practice Location Address
First Line	:	10555 MONTGOMERY BLVD NE STE 160
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3872
Country	:	US
Telephone Number	:	505-275-2492
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. COREY WOODS
Credential	:	DMD
Telephone Number	:	505-275-2492

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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