Healthcare Provider Details

I. General information

NPI: 1932929239
Provider Name (Legal Business Name): DENTAL SLEEP THERAPY OF MACON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 MARTIN LUTHER KING JR BLVD STE 103
MACON GA
31201-3476
US

IV. Provider business mailing address

105 BROADLEAF DR
MACON GA
31210-1921
US

V. Phone/Fax

Practice location:
  • Phone: 478-722-9865
  • Fax: 866-494-6123
Mailing address:
  • Phone: 478-722-1111
  • Fax: 866-494-6123

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. DOUGLAS S JOHNSON
Title or Position: MANAGING MEMBER
Credential: DMD
Phone: 478-722-9865