Healthcare Provider Details

I. General information

NPI: 1457157802
Provider Name (Legal Business Name): SUMMIT SLEEP SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 NE DOUGLAS ST
LEES SUMMIT MO
64086-4607
US

IV. Provider business mailing address

1399 NE DOUGLAS ST
LEES SUMMIT MO
64086-4607
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-0300
  • Fax:
Mailing address:
  • Phone: 816-373-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. RAVI RAJANNA
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 816-373-0300