Healthcare Provider Details

I. General information

NPI: 1346999679
Provider Name (Legal Business Name): PALM BEACH SLEEP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9884 SOUTHERN BLVD
ROYAL PALM BEACH FL
33411-3509
US

IV. Provider business mailing address

9884 SOUTHERN BLVD
ROYAL PALM BEACH FL
33411-3509
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-1020
  • Fax:
Mailing address:
  • Phone: 561-422-1020
  • Fax:

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: DR. STEVEN J BUSSELL
Title or Position: PRESIDENT
Credential: DMD
Phone: 561-422-1020