Healthcare Provider Details

I. General information

NPI: 1356700546
Provider Name (Legal Business Name): ASPEN DENTAL SLEEP MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 E VALLEY RD
BASALT CO
81621-8411
US

IV. Provider business mailing address

PO BOX 3251
BASALT CO
81621-3251
US

V. Phone/Fax

Practice location:
  • Phone: 970-319-2999
  • Fax:
Mailing address:
  • Phone: 970-319-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ALICE KANIFF
Title or Position: OWNER
Credential: DDS, D,ABDSM
Phone: 970-319-2999