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General NPI Number Information
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NPI Number | 1558801480
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Entity Type | Organization
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Legal Business Name | NORTHEAST OHIO CENTER FOR DENTAL SLEEP MEDICINE LLC
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Dates
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Enumeration Date | 02/25/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 22901 MILLCREEK BLVD SUITE #140
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City | BEACHWOOD
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State | OH
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Zip | 44122-5728
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Country | US
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Telephone | 216-831-1170
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Fax |
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Provider Business Mailing Address
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Address Line | 22901 MILLCREEK BLVD SUITE #140
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City | BEACHWOOD
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State | OH
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Zip | 44122-5728
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Country | US
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Telephone | 216-831-1170
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS E DESATNIK
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Credential | DDS
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Telephone | 216-831-1170
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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 | OH 30-023233
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License Number State | OH
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