Healthcare Provider Details

I. General information

NPI: 1265051874
Provider Name (Legal Business Name): MEDINA DENTAL SLEEP SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 RESERVE COMMONS DR
MEDINA OH
44256-8179
US

IV. Provider business mailing address

3617 RESERVE COMMONS DR
MEDINA OH
44256-8179
US

V. Phone/Fax

Practice location:
  • Phone: 330-722-7060
  • Fax:
Mailing address:
  • Phone: 330-722-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. SAILAJA G REDDY
Title or Position: DR/ OWNER
Credential: DMD
Phone: 330-573-4606