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General NPI Number Information
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NPI Number | 1265972137
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Entity Type | Organization
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Legal Business Name | DENTAL SLEEP THERAPY OF GREATER CINCINNATI PSC
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 265 MAIN ST
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City | FLORENCE
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State | KY
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Zip | 41042-2186
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Country | US
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Telephone | 859-371-4620
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Fax | 859-746-5192
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Provider Business Mailing Address
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Address Line | PO BOX 605
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City | FLORENCE
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State | KY
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Zip | 41022-0605
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. RONNIE DOUGLAS ELLIOTT JR.
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Credential | DMD
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Telephone | 859-282-1632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7616
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License Number State | KY
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