Healthcare Provider Details

I. General information

NPI: 1972900942
Provider Name (Legal Business Name): CENTER FOR TREATMENT OF SNORING AND SLEEP APNEA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4904 BORGEN BLVD NW STE A
GIG HARBOR WA
98332-5723
US

IV. Provider business mailing address

4904 BORGEN BLVD NW STE A
GIG HARBOR WA
98332-5723
US

V. Phone/Fax

Practice location:
  • Phone: 253-857-6778
  • Fax: 253-857-1030
Mailing address:
  • Phone: 253-857-6778
  • Fax: 253-857-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8549
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number8549
License Number StateWA

VIII. Authorized Official

Name: KIM RIOUX
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 253-857-6778