Healthcare Provider Details

I. General information

NPI: 1619481108
Provider Name (Legal Business Name): OHIO SLEEP TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ALKYRE RUN STE 300
WESTERVILLE OH
43082-6923
US

IV. Provider business mailing address

450 ALKYRE RUN STE 300
WESTERVILLE OH
43082-6923
US

V. Phone/Fax

Practice location:
  • Phone: 614-396-8286
  • Fax:
Mailing address:
  • Phone: 614-396-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number30.023922
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.023922
License Number StateOH

VIII. Authorized Official

Name: DR. BRANDON SCOTT CANFIELD
Title or Position: PARTNER
Credential: DDS
Phone: 614-286-1513