Healthcare Provider Details

I. General information

NPI: 1265972137
Provider Name (Legal Business Name): DENTAL SLEEP THERAPY OF GREATER CINCINNATI PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 MAIN ST
FLORENCE KY
41042-2186
US

IV. Provider business mailing address

PO BOX 605
FLORENCE KY
41022-0605
US

V. Phone/Fax

Practice location:
  • Phone: 859-371-4620
  • Fax: 859-746-5192
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7616
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. RONNIE DOUGLAS ELLIOTT JR.
Title or Position: DOCTOR
Credential: DMD
Phone: 859-282-1632