Healthcare Provider Details

I. General information

NPI: 1932527256
Provider Name (Legal Business Name): CENTER FOR DENTAL SLEEP MEDICINE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 EAST STUART #3140
FT COLLINS CO
80525
US

IV. Provider business mailing address

428 HOUSTON ST
MANHATTAN KS
66502
US

V. Phone/Fax

Practice location:
  • Phone: 855-774-0760
  • Fax:
Mailing address:
  • Phone: 785-776-0760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number05754
License Number StateCO

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MICHAELA L CLOSSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 785-776-0760