Healthcare Provider Details

I. General information

NPI: 1801420609
Provider Name (Legal Business Name): SLEEP DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 BUSCH BLVD STE 104
COLUMBUS OH
43229-6706
US

IV. Provider business mailing address

6500 BUSCH BLVD STE 104
COLUMBUS OH
43229-6706
US

V. Phone/Fax

Practice location:
  • Phone: 614-316-0262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. COLLIN EMERICK
Title or Position: PARTNER
Credential: DDS
Phone: 614-316-2062