Healthcare Provider Details

I. General information

NPI: 1881251544
Provider Name (Legal Business Name): DENTAL SLEEP SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 HAMPTON GRN
STATEN ISLAND NY
10312-1722
US

IV. Provider business mailing address

337 HAMPTON GRN
STATEN ISLAND NY
10312-1722
US

V. Phone/Fax

Practice location:
  • Phone: 718-984-1720
  • Fax:
Mailing address:
  • Phone: 718-984-1720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. VIVIAN DAMARIS BOTERO-NEBEL
Title or Position: OWNER
Credential: DMD
Phone: 718-984-1729