Healthcare Provider Details

I. General information

NPI: 1326404583
Provider Name (Legal Business Name): SLEEP EASY DENTAL SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MILTON BLVD
NEWTON FALLS OH
44444-9793
US

IV. Provider business mailing address

127 CHURCHILL HUBBARD RD
YOUNGSTOWN OH
44505-1386
US

V. Phone/Fax

Practice location:
  • Phone: 330-872-5737
  • Fax: 330-872-7400
Mailing address:
  • Phone: 330-759-4550
  • Fax: 330-759-4548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number15223
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number30.15233
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number30.024283
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES ROBERT VERBANIC
Title or Position: DENTIST
Credential: D.D.S.
Phone: 330-872-5737