Healthcare Provider Details

I. General information

NPI: 1346636727
Provider Name (Legal Business Name): OCALA DENTAL SLEEP CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2015
Last Update Date: 04/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5481 SW 60TH ST UNIT 202
OCALA FL
34474-5639
US

IV. Provider business mailing address

13979 NW 30TH AVE
GAINESVILLE FL
32606-9311
US

V. Phone/Fax

Practice location:
  • Phone: 352-653-3161
  • Fax:
Mailing address:
  • Phone: 352-332-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. IGOR GERMAN
Title or Position: OWNER/DENTIST
Credential: D.M.D.
Phone: 352-332-7351