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General NPI Number Information
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NPI Number | 1881942381
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Entity Type | Organization
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Legal Business Name | DENTAL SLEEP ALTERNATIVES, LLC
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 502 E STATE ST SUITE B
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City | GENEVA
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State | IL
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Zip | 60134-2363
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Country | US
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Telephone | 866-903-0747
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Fax | 866-910-6889
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Provider Business Mailing Address
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Address Line | 502 E STATE ST SUITE B
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City | GENEVA
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State | IL
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Zip | 60134-2363
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Country | US
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Telephone | 866-903-0747
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Fax | 866-910-6889
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL PONCZA
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Credential | DDS, D.ABDSM
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Telephone | 866-903-0747
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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 | 019026404
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License Number State | IL
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