Healthcare Provider Details

I. General information

NPI: 1457713745
Provider Name (Legal Business Name): SALT LAKE SLEEP DISORDER SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6364 S HIGHLAND DR SUITE 205
SALT LAKE CITY UT
84121-2117
US

IV. Provider business mailing address

6364 S HIGHLAND DR SUITE 205
SALT LAKE CITY UT
84121-2117
US

V. Phone/Fax

Practice location:
  • Phone: 801-634-2143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1427819922
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1427819922
License Number StateUT

VIII. Authorized Official

Name: DON BIGELOW
Title or Position: PRESIDENT
Credential: DDS
Phone: 801-634-2143