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General NPI Number Information
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NPI Number | 1174037436
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Entity Type | Organization
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Legal Business Name | DESERT MOUNTAIN SLEEP SOLUTIONS LLC
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Dates
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Enumeration Date | 11/24/2017
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Last Update Date | 11/24/2017
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Provider Practice Location Address
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Address Line | 6920 E SHEA BLVD STE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-6185
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Country | US
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Telephone | 480-991-3244
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Fax | 480-991-3244
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Provider Business Mailing Address
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Address Line | 7205 E SOUTHERN AVE STE A-122
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City | MESA
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State | AZ
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Zip | 85209-2790
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Country | US
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Telephone | 602-391-4107
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | TIM J WILDUNG
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Credential |
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Telephone | 602-391-4107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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