Healthcare Provider Details

I. General information

NPI: 1346642998
Provider Name (Legal Business Name): SURGICAL SLEEP SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S RESERVE ST
MISSOULA MT
59801-2104
US

IV. Provider business mailing address

3001 ALBANS RD
HOUSTON TX
77005-2145
US

V. Phone/Fax

Practice location:
  • Phone: 281-772-1151
  • Fax:
Mailing address:
  • Phone: 281-772-1151
  • Fax: 281-569-4608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number7822
License Number StateMT

VIII. Authorized Official

Name: ADAM MAURER
Title or Position: CEO
Credential:
Phone: 281-772-1151