Healthcare Provider Details

I. General information

NPI: 1437524824
Provider Name (Legal Business Name): CENTRAL MASS SLEEP SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S MAIN ST
LEICESTER MA
01524-1403
US

IV. Provider business mailing address

119 S MAIN ST
LEICESTER MA
01524-1403
US

V. Phone/Fax

Practice location:
  • Phone: 508-892-4882
  • Fax: 508-892-4279
Mailing address:
  • Phone: 508-892-9417
  • Fax: 508-892-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17984
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN J MILLETTE
Title or Position: OWNER
Credential: DMD
Phone: 508-887-3896