Healthcare Provider Details

I. General information

NPI: 1336613330
Provider Name (Legal Business Name): DENTAL SLEEP PROVIDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 MAIN ST STE 303
MANCHESTER CT
06040-6064
US

IV. Provider business mailing address

945 MAIN ST STE 302
MANCHESTER CT
06040-6064
US

V. Phone/Fax

Practice location:
  • Phone: 860-643-5350
  • Fax: 860-646-5807
Mailing address:
  • Phone: 860-643-5350
  • Fax: 860-646-5807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BRADLEY J. DAAR
Title or Position: DENTIST/OWNER
Credential: DDS, MS
Phone: 860-643-5350