=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811295181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIE DENTAL SLEEP THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2011
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3736 STERRETTANIA RD
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16506-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-836-2866
-----------------------------------------------------
Fax | 814-217-6811
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3736 STERRETTANIA RD
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16506-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-836-2866
-----------------------------------------------------
Fax | 814-217-6811
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN H. TUCKER
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 814-836-7777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS023159L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------