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General NPI Number Information
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NPI Number | 1760935332
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Entity Type | Organization
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Legal Business Name | ABSOLUTE SLEEP TREATMENT CENTER
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 2065 AIRWAY AVE SUITE B
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City | KINGMAN
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State | AZ
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Zip | 86409-3656
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Country | US
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Telephone | 928-718-0002
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Fax | 928-718-0007
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Provider Business Mailing Address
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Address Line | 2065 AIRWAY AVE SUITE B
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City | KINGMAN
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State | AZ
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Zip | 86409-3656
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Country | US
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Telephone | 928-718-0002
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Fax | 928-718-0007
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | THEODORE SPALDING KIMBALL III
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Credential | D.D.S.
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Telephone | 928-718-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | 4670
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License Number State | AZ
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