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General NPI Number Information
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NPI Number | 1457713745
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Entity Type | Organization
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Legal Business Name | SALT LAKE SLEEP DISORDER SOLUTIONS LLC
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 6364 S HIGHLAND DR SUITE 205
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-2117
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Country | US
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Telephone | 801-634-2143
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Fax |
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Provider Business Mailing Address
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Address Line | 6364 S HIGHLAND DR SUITE 205
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-2117
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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 | PRESIDENT
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Name | DON BIGELOW
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Credential | DDS
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Telephone | 801-634-2143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1427819922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 1427819922
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License Number State | UT
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