Healthcare Provider Details

I. General information

NPI: 1568076701
Provider Name (Legal Business Name): ALTERNATIVE SLEEP SOLUTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 KANELL BLVD.
POPLAR BLUFF MO
63901
US

IV. Provider business mailing address

2700 KANELL BLVD.
POPLAR BLUFF MO
63901
US

V. Phone/Fax

Practice location:
  • Phone: 573-712-8966
  • Fax: 573-785-3840
Mailing address:
  • Phone: 573-712-8966
  • Fax: 573-785-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GEORGE F BLAICH IV
Title or Position: DENTIST/CO-OWNER
Credential: D.M.D.
Phone: 573-785-0111