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General NPI Number Information
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NPI Number | 1669077335
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Entity Type | Organization
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Legal Business Name | SUNRISE SLEEP AND TMJ SOLUTIONS LLC
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/21/2020
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Provider Practice Location Address
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Address Line | 375 N MAIN ST STE 204
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City | KAYSVILLE
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State | UT
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Zip | 84037-1278
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Country | US
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Telephone | 384-209-1836
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Fax |
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Provider Business Mailing Address
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Address Line | 375 N MAIN ST STE 204
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City | KAYSVILLE
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State | UT
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Zip | 84037-1278
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Country | US
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Telephone | 384-209-1836
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD BUCK
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Credential | DMD
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Telephone | 757-849-8941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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