Healthcare Provider Details

I. General information

NPI: 1730473034
Provider Name (Legal Business Name): DENTAL SLEEP MED SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 MCHENRY AVE SUITE N
MODESTO CA
95350-1466
US

IV. Provider business mailing address

3025 MCHENRY AVE SUITE N
MODESTO CA
95350-1466
US

V. Phone/Fax

Practice location:
  • Phone: 209-527-1995
  • Fax: 866-527-2335
Mailing address:
  • Phone: 209-527-1995
  • Fax: 866-527-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number27009
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number26675
License Number StateCA

VIII. Authorized Official

Name: DR. MARTY RICHARD LIPSEY
Title or Position: PRESIDENT
Credential: D.D.S., M.S.
Phone: 209-527-1995