Healthcare Provider Details

I. General information

NPI: 1063023430
Provider Name (Legal Business Name): WESTSIDE DENTAL SLEEP CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18611 DETROIT AVE
LAKEWOOD OH
44107-3205
US

IV. Provider business mailing address

30701 LORAIN RD STE A
NORTH OLMSTED OH
44070-6325
US

V. Phone/Fax

Practice location:
  • Phone: 216-221-2210
  • Fax:
Mailing address:
  • Phone: 440-274-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL S PAP
Title or Position: PRESIDENT
Credential: DDS
Phone: 216-221-2210