Healthcare Provider Details

I. General information

NPI: 1811295181
Provider Name (Legal Business Name): ERIE DENTAL SLEEP THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 STERRETTANIA RD
ERIE PA
16506-2829
US

IV. Provider business mailing address

3736 STERRETTANIA RD
ERIE PA
16506-2829
US

V. Phone/Fax

Practice location:
  • Phone: 814-836-2866
  • Fax: 814-217-6811
Mailing address:
  • Phone: 814-836-2866
  • Fax: 814-217-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS023159L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN H. TUCKER
Title or Position: OWNER
Credential: DMD
Phone: 814-836-7777