Healthcare Provider Details

I. General information

NPI: 1306347877
Provider Name (Legal Business Name): PRECISION DENTAL SLEEP THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 MAIN ST STE 7
SPARTA NJ
07871-1933
US

IV. Provider business mailing address

13 MAIN ST STE 7
SPARTA NJ
07871-1933
US

V. Phone/Fax

Practice location:
  • Phone: 973-729-5900
  • Fax:
Mailing address:
  • Phone: 973-729-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI02246400
License Number StateNJ

VIII. Authorized Official

Name: DR. ANNA PATRAS
Title or Position: MANAGING MEMBER
Credential: DMD
Phone: 973-729-5900