Healthcare Provider Details

I. General information

NPI: 1457133167
Provider Name (Legal Business Name): SLEEP APNEA CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W MCDOWELL RD STE B
PHOENIX AZ
85003-1223
US

IV. Provider business mailing address

125 W MCDOWELL RD STE B
PHOENIX AZ
85003-1223
US

V. Phone/Fax

Practice location:
  • Phone: 240-715-8035
  • Fax:
Mailing address:
  • Phone: 240-715-8035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIJA MITIC
Title or Position: DENTIST, OWNER
Credential: DDS
Phone: 240-715-8035