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General NPI Number Information
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NPI Number | 1194295741
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Entity Type | Organization
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Legal Business Name | EZ SLEEP SOLUTIONS, INC.
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Dates
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Enumeration Date | 11/27/2018
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 230 E. JEFFERSON
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City | MANGUM
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State | OK
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Zip | 73554
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Country | US
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Telephone | 590-782-2552
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Fax |
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Provider Business Mailing Address
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Address Line | 230 E JEFFERSON ST STE B
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City | MANGUM
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State | OK
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Zip | 73554-4202
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Country | US
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Telephone | 590-782-2552
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DUSTIN CURT LIVELY
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Credential | DDS
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Telephone | 580-782-2027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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