Healthcare Provider Details

I. General information

NPI: 1306525399
Provider Name (Legal Business Name): BREATHE SLEEP DREAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1674 PROVIDENCE BLVD
DELTONA FL
32725-4961
US

IV. Provider business mailing address

1674 PROVIDENCE BLVD
DELTONA FL
32725-4961
US

V. Phone/Fax

Practice location:
  • Phone: 386-218-3316
  • Fax:
Mailing address:
  • Phone: 386-218-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOANNA LYNN SCHAFFER
Title or Position: MANAGER/AUTHORIZED OFFICIAL
Credential:
Phone: 386-218-3316