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General NPI Number Information
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NPI Number | 1740794569
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Entity Type | Organization
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Legal Business Name | SLEEP APNEA TREATMENT CENTRE OF AMERICA LLC
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 12/01/2017
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Provider Practice Location Address
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Address Line | 5100 W TAFT RD STE 4N
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City | LIVERPOOL
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State | NY
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Zip | 13088-3807
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Country | US
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Telephone | 315-458-8844
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Fax |
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Provider Business Mailing Address
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Address Line | 5068 PINE VALLEY DR
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-9723
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Country | US
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Telephone | 315-882-5042
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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. BRENT A BRADFORD
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Credential | DDS
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Telephone | 315-882-5042
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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 | 048823
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License Number State | NY
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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 | 048823
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License Number State | NY
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