Healthcare Provider Details

I. General information

NPI: 1144546441
Provider Name (Legal Business Name): SNORING AND SLEEP APNEA CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13734 1ST ST SUITE B
BECKER MN
55308-9337
US

IV. Provider business mailing address

13734 1ST ST SUITE B
BECKER MN
55308-9337
US

V. Phone/Fax

Practice location:
  • Phone: 763-262-7645
  • Fax: 763-262-2345
Mailing address:
  • Phone: 763-262-7645
  • Fax: 763-262-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE GRUENES
Title or Position: OWNER
Credential: DDS
Phone: 763-262-7645