Healthcare Provider Details

I. General information

NPI: 1164396651
Provider Name (Legal Business Name): PANHANDLE SLEEP DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 4TH AVE STE D
CRESTVIEW FL
32539-2401
US

IV. Provider business mailing address

101 4TH AVE STE D
CRESTVIEW FL
32539-2401
US

V. Phone/Fax

Practice location:
  • Phone: 850-683-3544
  • Fax: 850-683-4503
Mailing address:
  • Phone: 850-683-3544
  • Fax: 850-683-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA MARIE TURGEON
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 850-683-3544